The good news on medical schemes is that the industry is turning around from huge losses. The bad news is that nobody's tracking how much medical costs consumers are carrying. On average, the industry performed pretty well, according to acting registrar of medical schemes Patrick Matshidze.

Closing date: 14 December 2007
Salary: R369 000 per annum (MMS Inclusive Package) (Ref. G26965/6) - Klerksdorp/Tshepong Hospital Complex

It seems you cannot open a newspaper or financial journal anywhere in the world without finding articles about the unacceptable cost of private healthcare, or the high rate of medical inflation. In South Africa, these articles are embedded with doom and gloom the very survival of the private healthcare system is called into question on a regular occasion.

Governments plans to place all its employees on a single medical scheme would increase the states control over the medical benefits it provided to public servants, save money, and help relieve the burden on public hospitals and clinics, Public Service and Administration Minister Geraldine Fraser-Moleketi said yesterday.

The purpose of this research project was to provide information which would contribute to debates about restructuring of the PDS system. In particular, patient satisfaction with current PDS services was evaluated, and the opinions of PDSs and patients about possible changes to the PDS system were surveyed. This was accomplished through exit poll interviews with 638 PDS patients (the user survey) and a questionnaire survey of 58 PDSs (the PDS survey). These surveys were conducted in three provinces, namely the Western Cape, Northern Cape and the Free State.

UNIVERSITY OF THE WITWATERSRAND, JOHANNESBURG

DIVISION OF RURAL HEALTH, DEPARTMENT OF FAMILY MEDICINE

Medical School, 7 York Road, Parktown 2193 South Africa
Tel: 011 717 2041
Fax: 011 717 2558
18^th WITS SKILLS TRAINING COURSE

The next Wits Clinical Skills Course will be held on Friday 16^th October 2009.

There is a major shortage of doctors in rural areas in South Africa. About 46% of the population in South Africa live in non-urban areas (1), and they do not always have the same access to health services as their urban counterparts. One example is Mount Frere district, where the doctor to population ration is 1:30 000 (2).

Private sector healthcare in South Africa ranks with the best in the world, yet barely 30% of the population can access it. The remaining 70% cannot afford private healthcare, placing the responsibility in the public sector. The Medical Schemes Act was intended to widen private sector membership by outlawing discrimination on any basis other than family size and income, but that has not happened yet. By removing the capacity to cherry-pick the best risks, schemes will have to compete by negotiating better deals with hospitals, doctors and other service providers. Soon, schemes will need to enter into risk-sharing arrangements with providers to bring down costs in a sustainable way. Coupled with better product design, this should make healthcare more affordable to the poor. Few schemes are geared up for risk-sharing arrangements. Prime Cure, a primary care provider group owned by its managers and three private equity groups, has built a network of 50 medical centres around the country delivering quality low-cost healthcare. While patients have access to comprehensive primary care from general practitioners and nurses and specialist services such as radiology and pathology, the group manages to turn a decent profit. Prime Cure contracts with a further 250 service providers around the country, expanding its reach beyond the 50 centres. These protocols are integrated into an IT system which doctors can access in real time. This means doctors generally get it right the first time, without hazarding their way through treatments and running up big medical bills. Prime Cure centres are streamlined, with support staff doing the grunt work, allowing doctors to see 90 or more patients a day, about double the industry norm. Prime Cure is paid a fixed fee per patient, eliminating incentives to over-service. Its patients fall into three categories: those with medical aids (who can consult a doctor and purchase drugs for about a third the normal cost of a consultation with a GP and the resulting prescription); cash patients (who are charged R60 to R90 for consultation, medicine and any specialist service needed, such as radiology); and, capitation patients: Prime Cure is contracted by 15 medical aids to provide fixed-fee services for 120 000 members. Prime Cure was started six years ago and it took more than four years to show a profit. As it achieved critical mass, the group leveraged its bulk purchasing power and wrung costs from the system through use of generic drugs and other cost-containment tools. It is this kind of health service the government wants to see proliferate. (Source: Business Times, 16 June 2002)

This briefing summary is based upon chapters 7 and 8 of the South African Health Review 1999

The Rural Doctors' Association of Southern Africa will be holding its 4th Annual Congress from 22-24 September 2000 at Queen's Boys High School, Queenstown, Eastern Cape. The theme is: the rural general practitioner - an integrator in rural health care.