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The South African Medical Association (Sama) believes that the Competition Commission Health Market Inquiry (HMI) provisional report is faulty in its findings, particularly that doctors increase demand for unnecessary services.
Sama is particularly concerned about the allegations that doctors increase demand of unnecessary services, including increased admissions to hospitals, says chairperson, Dr Mzukisi Grootboom.
“The HMI reached this conclusion after analysing claims data. We are of the considered view that the methods used by the HMI were not robust enough to conclude that many admissions are unexplained and thus constitute a doctor-induced moral hazard,” he says.
In 2017, the Medical Research Council presented to Parliament the top 10 diseases that kill South Africans. These included HIV and Aids, cerebrovascular disease, lower respiratory tract infections, ischaemic heart disease, tuberculosis, diabetes mellitus, hypertension, interpersonal violence, other trauma-related injuries, liver disease and diarrhoeal illnesses. In 2015, Statistics South Africa reported cancer to be the fifth cause of death in the country.
“Typically the private sector uses the Prescribed Minimum Benefit Chronic Conditions List (PMB CDL list) to define chronic conditions. The list only includes three of the conditions which kill South Africans. The HMI can therefore not conclude that there are unexplained admission after adjusting only for chronic diseases and age. Sama believes the increase in admission can be explained by high prevalence of injuries, acute infections, cerebrovascular accidents, cancer, tuberculosis, and substance abuse, amongst other factors,” says Grootboom.
Dr Grootboom says it is also concerning that the HMI assumed all psychiatry and paediatric admissions are discretionary. This is patently wrong.
“This cannot be true given the recent developments in mental health. If psychiatry admissions are really discretionary, we would not have witnessed the development of the Life Esidemeni crisis. No doctor will choose to admit a mental health patient if an option for community-based care exists. In a country where high causes of mortality rates in children include lower respiratory tract infection and diarrhoea, assuming that all paediatric admissions are discretionary is quite flawed,” Grootboom notes.
The HMI analysed the proportion of discretionary admissions in 10 specialities. He says it is astounding that all cardiology and cardiothoracic admissions appear to have been considered discretionary against the backdrop of ischaemic heart disease being responsible for a significant proportion of deaths in the country.
He notes that almost all of urology and orthopaedics admissions were also considered discretionary.
“Treatment of hip fracture with arthroplasty or early prostate cancer is not discretionary; these are the standards of care,” he says.
In addition Grootboom notes that black men in South Africa are more likely to suffer aggressive forms of malignancies or cancer and that a watch and wait strategy is therefore clinically not appropriate in our setting.
Further to the report’s findings that unpaid claims should be construed as unnecessary care, Grootboom says schemes typically do not fund clinically appropriate care if they judge it is not a prescribed minimum benefit and not covered by plan type.
“Unfortunately, the allegations of doctor-induced demand can erode the patient-doctor trust. As a profession we will continue doing our level best to care for and save the lives of all South Africans. We will also further engage with the HMI after a complete analysis of this lengthy document.”
Duduzane Zuma to appear in court
Duduzane Zuma will appear in the Specialised Commercial Crime Court in Johannesburg on Monday, his lawyer confirmed over the weekend.
“Yes, he will be [appearing],” lawyer Rudi Krause told News24 on Sunday.
City Press reported that he was set to be charged with corruption – apparently in connection with the role he allegedly played in an incident where former deputy finance minister Mcebisi Jonas has said there was an attempt to bribe him at the Guptas’ Saxonwold home in 2015.
According to the newspaper, sources from the Hawks had revealed Zuma would be charged with contravening the Prevention and Combating of Corrupt Activities Act.
Zuma has apparently been overseas since February; however, his brother, Vusi Nhlakanipho Zuma, died recently of lupus and Duduzane came to attend his funeral.
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JOHANNESBURG – Suspended SARS commissioner Tom Moyane will host a media briefing at the Wanderers in Johannesburg on Monday.
Moyane, who is facing a disciplinary inquiry at the revenue service, is expected to speak about his term at the helm and his reaction to a response from the president.
He is also expected to comment on the Nugent inquiry into SARS.
Last week, SARS commission chairperson Judge Robert Nugent rejected Moyane’s request to postpone the probe into SARS until after his (Moyane’s) disciplinary inquiry.
Moyane then wrote to President Cyril Ramaphosa asking for a postponement one or both of the SARS inquiry or his disciplinary inquiry.
Moyane claims that both processes are unfair.
eNCA
Benjamin Pavard (Supplied)
Jeumont – It has been a remarkable rise – two years after supporting France at Euro 2016 from a fan zone, Benjamin Pavard is preparing to represent his country in a World Cup semi-final.
READ: England’s SWC win draws massive TV numbers
Pavard has already lit up the tournament with his wonder strike against Argentina. But the 22-year-old has never forgotten his roots in the little town of Jeumont, on the border with Belgium in northern France.
Coincidentally Belgium now stand between Pavard and Les Bleus, and a place in the World Cup final.
“To show that you can be born here, live and grow up in Jeumont and go on to succeed at the highest level of international football is a wonderful lesson for the children of Jeumont and it gives them hope for the future,” says local mayor Benjamin Saint-Huille.
He has ensured that banners in support of their hero have been displayed around the little town of 10 000 inhabitants, an hour’s drive south of Lille,
The 22-year-old right-back grew up in Jeumont, but he is not the first football star from the town – Jean-Pierre Papin, the prolific former France and Marseille striker also hails from there.
Pavard started playing aged six, and his talent was immediately obvious.
“At that age he was already doing 50 keepy-ups, right foot, left foot, head. He could do everything, it was impressive,” recalls Sullivan Skiba, who coached Pavard in his early days.
It did not take the Pavard long to be spotted by Lille, and he joined the academy of the region’s leading club.
A reserved personality, he turned out in central defence and sometimes in midfield. Little by little, he began to assert himself.
“When he had to work, he was very serious. But outside, he was a bit of a joker, and he would turn his 1980s music up full blast. He was a rule-breaker,” Corentin Halucha, who was at the Lille academy at the same time as Pavard, tells AFP.
‘A golden kid’
Then Pavard got lucky when first-team coach Rene Girard, impressed by his versatility, handed him his professional debut in 2015.
“What really astounded me was his maturity. We saw that he was capable of playing anywhere across the defence with the same success, so we did not hesitate,” said Girard.
However, when Girard left, Pavard found himself out of favour, and the young defender decided to join VfB Stuttgart, the German giants who had just been relegated from the top tier of the Bundesliga. It was an inspired move.
Pavard helped Stuttgart win promotion in his first season and won his first cap for France in late 2017.
Reports say his performances at the World Cup have attracted the interest of Bundesliga champions Bayern Munich.
“Football is also about opportunities. The train came along, he got on and now he is travelling in first class,” says Halucha, who watched France games at Euro 2016 with Pavard at the UEFA fan zone in Lille.
But Pavard has not let that fame, acquired in such a short space of time, get to his head.
“He has always thanked me and he sends me a message when anything happens in his career,” says Girard. “He is very grateful and that is not the case for everyone. He is a golden kid.”
Skiba says that Pavard “does not forget where he came from”, and will happily sign autographs and play with the youngsters whenever he returns to Jeumont.
“He is a real ‘Ch’ti'”, he adds, using the term for a native of France’s far north.
So much so, in fact, that his France teammates call him “Jeff Tuche”, after the character with the curly hair and moustache from the farcical French comedy films “Les Tuche”, about a working-class family who win the lottery.
Pavard may not appreciate the resemblance – it is easy to see why – but for his team-mates it is all in good humour.
“He played for Lille like me, so that has brought us together,” said defender Adil Rami. “I like players like him, with their nice, sweet side, but then they get stuck in and give their body over to science.”
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