Pretoria, 31 July 2018 – The South African Revenue Service (SARS) today releases trade statistics for June 2018 recording a trade balance surplus of R12.00 billion. These statistics include trade data with Botswana, Lesotho, Namibia and Swaziland (BLNS). The year-to-date (01 January to 30 June 2018) trade balance deficit of R1.79 billion is a deterioration on the surplus for the comparable period in 2017 of R25.00 billion. Exports year-to-date increased by 1.5% whilst imports for the same period showed an increase of 6.6%.
South Africa’s Unemployment Rate per Province for 2nd Quarter 2018
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Health24.com | You have 11 seconds to tell your doc what’s wrong
Eleven seconds.
That’s how long you typically have to tell your doctor what’s wrong with you before he or she interrupts you and possibly side-tracks the conversation, a new study shows.
Speak up
“These findings are obviously concerning. We would like our physicians to listen for more than 11 seconds,” said study author Dr Naykky Singh Ospina. She’s an assistant professor of endocrinology at the University of Florida.
The researchers also found that doctors were able to find out the patient’s primary reason for the visit only about one-third of the time.
The study authors noted that the medical interview is one of the key components of medicine. It helps to build a good doctor-patient relationship.
The study was published online recently in the Journal of General Internal Medicine.
Although the study didn’t delve into the specific reasons for the interruptions or lack of finding out a patient’s agenda, the researchers said there are a number of factors that could play a role.
Identifying patient’s agenda
These include time constraints and physician burnout, because today’s physicians also have to navigate complicated and time-consuming health insurance issues. And for doctors trained before 2004, when physician training underwent a significant shift, a limited education in patient communication skills may also be a factor.
In the study, the researchers analysed information from a random sample of 112 doctor-patient encounters from a study of 700 doctor-patient visits. The original study was done to test how well shared decision-making tools for treatments for chronic conditions worked. The patients visited doctors in Minnesota and Wisconsin.
Sixty-one visits were with primary care doctors and 51 were with specialists. Forty-five doctors were female senior clinicians. Sixty-four patients were female.
The average visit lasted 30 minutes, the findings showed. The patient’s agenda was only identified in 36% of the visits. When the patient agenda was identified, the average visit lasted 35 minutes.
Active listening
Primary care docs seemed to best specialty care physicians by a wide margin – nearly half of primary care doctors found out the main reasons patients were visiting. But only 20% of specialty care doctors did so. However, Singh Ospina said because the study sample was small, this difference didn’t reach statistical significance.
She also pointed out that when you go to a specialist, you often go with a referral for a specific condition. For example if you go to an endocrinologist, you probably went with a referral for diabetes treatment, so the doctor already knows the main reason for your appointment.
Dr Aaron Bernard, director of clinical arts and science at the Netter School of Medicine at Quinnipiac University, said the new findings are in line with previous research.
“Physicians could be more open-ended in their questioning and let patients share their concerns. This study highlights the need for continued education of students and for practicing physicians. Performing tasks such as active listening are to everyone’s benefit,” he said.
Bernard said he hopes newer doctors are better at communicating well with patients. Since 2004, there has been a clinical skills exam portion in the battery of tests that doctors must pass to get their medical license. This has led medical schools to invest more in clinical skills education, he explained.
Patients should have a sense of the most important things they want to address before they go to the doctor, Bernard suggested. Most doctors will start with an open-ended question such as, “What brings you here today?” he said. “Take advantage of that opening. Don’t hold back.”
Fixing the problem
Bernard pointed out that it’s usually to the physician’s advantage to listen more up front. “Force yourself to wait for the information. If you don’t get all the information from the patient up front, you may find yourself constantly going back into the room to play catch up,” which wastes everybody’s time.
Singh Ospina said she hopes physicians will use the findings to re-evaluate their patient communications.
“(Doctors should) stop and pay attention for a day or two to see if they are talking more to the patient and not allowing them to speak,” she said. “We commonly don’t ask what a patient’s main concern is, and if we don’t know there’s a problem, we can’t fix it.”
Image credit: iStock
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Explainer: how competitive is South Africa’s private healthcare sector
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Why was a market inquiry set up?
The inquiry was set up because private healthcare and medical scheme cover is expensive in South Africa. Costs continue to rise and fewer people can afford it. People who have health insurance find that the scheme covers less care and they often have to pay out of pocket.
Also, the private healthcare sector consumes a large amount of the healthcare spend and resources despite the fact that it only serves a small portion of the population. The private healthcare market serves about 18% of the population who buy healthcare insurance sold by medical schemes. But the private market consumes about half of the total health spend every year.
What did you find about competition – or lack of – in the sector?
The first thing to realise is that this is a complicated market with lots of different players in it so there isn’t a straightforward easy answer. It’s complex.
The report talks about a funder market. What is this and what did you find?
By funders we mean the companies that purchase healthcare. This includes medical schemes, the administrators that schemes use and the managed care organisations that the schemes contract with. We found that competition doesn’t operate as it should on the funder side of the market.
Basically what schemes do is pool the money that members of schemes give in premiums each month. The point of health insurance is to enable money to be pooled so that the healthy can cross-subsidise the sick. Over time it evens out.
Health insurance is there to protect people from catastrophic expenditure. Members should want their scheme to be careful and wise with their money.
Is this not happening and if not why not?
We think this isn’t happening for a number of reasons. It’s not to do with schemes being bad. It’s about the way the market operates.
One of the reasons it’s hard to know if schemes are being wise is that consumers don’t have the information they need. There are about 270 different health care plans on offer from all the various medical aid schemes – each offers different cover and costs a different amount. It’s very difficult to compare them and work out which option offers the best bang for a person’s buck.
We have recommended that all schemes have to offer a basic package that offers the same care. Consumers could then compare like with like.
On top of this there are also regulatory problems (rules about how schemes work) where we recommend changes so that it’s easier for schemes to offer a single comparable package.
So one package is one solution. But how does a person know if the quality is good or bad?
In the private market there are no measures of quality that are shared with the public. Consumers don’t know if a hospital is good or bad. There is also no way to judge if care being provided by doctors and specialists is effective as there are no measures on whether or not people are better afterwards.
This can lead to more and more interventions – and a waste of money.
If data are pooled and lots of doctors and patients report about health outcomes, we can begin to know if having an extra test or some kind of intervention works. We make a recommendation about reporting on quality and outcomes.
You looked at hospitals – what did you find?
We found that is a very high level of concentration in the hospital sector. Three hospital groups dominate: Netcare, Mediclinic and Life. They have more than 80% of the hospital beds available and get 90% of all the admissions. This distorts and restricts competition.
We have made some recommendations around this. But one thing we think is essential is a supply side regulator that would, among other things, assist provinces in issuing licenses for hospitals. Some countries, like Germany, are very strict about the number of beds available in the hospital sector.
The report also talks about doctors, what did you find?
There are problems when it comes to the way doctors and specialists work. They work as individuals – not as a team. Team-based care is an internationally accepted standard because it provides better care and can be more cost effective. But our system doesn’t allow this easily.
Also doctors and specialists use a fee-for-service billing model. This means they bill patients for each service they perform during a consultation. Obviously people inclined to maximise their income they will do more so they earn more. There is no good mechanism to manage this.
This is a universal problem. Different countries have different ways of managing it. In Sweden, for example, almost all specialists are salaried and paid by the state. So they don’t have an incentive to do more to earn more.
There is a chapter supply induced demand. What’s that about?
Basically it means that when some additional care is offered (increased access), additional use of the service that would not have otherwise have happened takes place.
This has two consequences: wasteful expenditure and patients being over serviced.
*How does South Africa compare to other countries? *
When it comes to the private healthcare sector South Africa faces a problem of over-servicing and over supplying. Three examples illustrate this.
Firstly, hospital admission rates are extremely high. South Africa’s rate was higher than all but two of 17 other OECD countries we used as comparisons.
We also looked at seven different surgical procedures. In four, South Africa had the highest usage rates.
Lastly we looked at the number of people that get admitted to intensive care units. We found that South Africa had higher admission rates than eight other countries with comparable published data.
What will it take to break the current patterns?
We recommend that the regulatory regime needs to be improved. Regulators aren’t as sensitive to competition issues as they could be. South Africa has laws in place but they aren’t being fully used. Stewardship from the Department of Health has also been weak.
But we were also very aware that there is no quick fix. The market is incredibly complex. This means that several interrelated interventions are needed. Market failures will persist if the recommendations aren’t introduced as a package.
We also kept in mind that the country is trying to move towards a system of universal health coverage and we have been mindful not to undermine that vision.
What, in summary are your main recommendations?
- The way in which schemes operate needs to change. This should include the way options are structured so that people can compare apples with apples. We hope that will improve accountability in the funder market.
- More transparency: a system needs to be put in place that allows people to see what value they’re getting for what they’re paying for.
- Greater competition, especially in the hospital sector is needed.
This article was originally published on The Conversation. Read the original article.
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Grilled Salmon Club
How to Make It
Step 1
When you buy salmon, ask fishmonger to remove skin and package it up for you. Cut salmon flesh into 4 pieces and rub with 1/2 tsp. sesame oil. Season with salt and pepper. Let stand at room temperature for 20 minutes.
Step 2
Preheat oven to 400°F. Line a small baking sheet with foil and lightly grease foil. Place salmon skin scale-side up in a single layer on baking sheet (cut in half to fit, if needed); rub with 1/2 tsp. sesame oil. Sprinkle with sesame seeds and season with a pinch of salt. Roast until skin is crispy and golden, about 15 minutes. Transfer salmon skin to a paper towel-lined plate to drain. Cut crosswise into baconlike strips.
Step 3
Preheat broiler. Brush bread with olive oil; broil until lightly browned, 45 to 60 seconds per side. In a bowl, mix mayonnaise with sriracha, lemon juice and remaining sesame oil.
Step 4
Preheat a grill pan over medium-high heat. Grill salmon, turning once, until just cooked through, 5 to 6 minutes. Transfer to a paper towel-lined plate and pat dry.
Step 5
Arrange bread on a cutting board and spread with sriracha mayonnaise. On 4 slices, arrange tomatoes, pickles, salmon, arugula and salmon-skin bacon. Close sandwiches and serve right away.