• 2016-09-03

    Interesting times

    We are certainly living in interesting times, with huge changes imminent in the Healthcare sector.  The current Health Market Inquiry is raising interesting issues, which many of us have perhaps been asking ourselves, but been too accustomed to "this is just the way it is, and always has been" to challenge the status quo.  I am certain that with the release of the final report by the Competition Commission, we will get the first glimpse of a new era in private healthcare in South Africa.  One of the key issues that has been raised numerous times in presentations to the Commission has been the one of Corporate Employment, or Corporate Involvement.  I watch this space with bated breath. 

    Before getting into the detail around what has been proposed, what has been ruled by various industry role players, and where this may take us, we need to pause and ask ourselves the question "What is my view of Corporate Involvement in the healthcare sector in South Africa?"  Well, are you for it, or against it?  Consider the plight of the nursing profession.  Are they better off in a situation where the majority of the nursing profession is employed by large JSE listed healthcare companies?  Has their profession as a whole advanced and developed in this environment?  Has there been an impact on their clinical autonomy?  Not to mention where independent pharmacists find themselves. 


    Various party views and rulings


    The Health Professions Council of South Africa (HPCSA), the regulatory authority and statutory council of more than 200 000 Healthcare Professionals in South, has recently published a media statement, in which they proclaim that a Psychologist has been "struck off the register" as he was:

    • Found guilty of unprofessional conduct as he allowed himself to be used by person(s) not registered with the HPCSA to score psychological tests.
    • Scored test answer sheets provided by an unregistered person(s).
    • Worked and/or collaborated with a psychological process that was clearly flawed and whose validity and reliability was questionable.

    Furthermore, within this media statement, "The HPCSA urges all practitioners to safe guard their profession by not employing or be employed by practitioners who are not registered with the HPCSA.

    Competition Commission

    While the current Health Market Inquiry is underway as part of the Competition Commission mandate to investigate if there are any features of the sector that prevent, distort or restrict competition, there have been historic rulings by the Competition Commission, through the Competition Tribunal, giving us a view of their thinking to date.

    In the Competition Tribunals ruling against a party within the Optometry industry, the principles of non-corporate ownership or investment have been upheld.  The party failed at its request in setting aside the Ethical Rules promulgated by the HPCSA under the Health Professions Act (“HPA”), as well as the Policy Document on Undesirable Business Practices by the HPCSA and the Board restrict corporate investment and/or corporate ownership by lay persons. In short, persons who are registered under the HPA to practice optometry cannot work for an entity in which all its directors, shareholders or partners are not professionals themselves.  

    The HPCSA stated that “an important principle has successfully been defended.”  A competition law expert said “this is an important victory for the health professions. An adverse finding would have had far reaching implications not just for the optometry profession, but all health professions, as the prohibitions apply to all professions.” 

    However, on 20 January 2015, the claimant lodged an appeal against the decision of the Tribunal at the Competition Appeal Court. In the appeal case of 17 June 2015, the Competition Appeal Court ruled in favour of the original ruling of the Tribunal, thereby upholding the findings.

    Hospitals employing Healthcare Professionals

    A judgement by the Pretoria High Court on the 28th April 2016, rules in favour of Netcare Hospitals (Pty) Ltd accrediting them to ..."employ medical physicists and radiotherapists registered with the Health Professions Council of South Africa at those of its hospitals that provide oncology health care services, in accordance with employment contracts which comply with Rule 18 contained in the Schedule to the Ethical Rules of Conduct for Practitioners Registered under the Health Professions Act, 56 of 1974."


    Appeals to the Health Market Inquiry to allow for Corporate Employment

    With the majority of the public hearings drawn to a close, it is interesting to reflect back on the transcripts of these hearings, to see what the general opinions are relating to employment of healthcare professionals.  Here are some extracts from the hearings, for you to decide for yourself:

    Life Healthcare

    "In terms of doctor employment, I know that you hear from a doctor saying they should not be employed by hospitals, we would like to have the approval to employ doctors, that is not to say that we would go out and employ every doctor in our group, but we do think that we would like to have the ability to employ doctors, we do think would have influence in terms of some of the qualities care, and the cost effectives of that care."


    "It is easier for obvious reasons in an employment model to get compliance to protocols, to develop those protocols, and I don’t want to use the word, enforce, but to get compliance from your workforce.  On the income or profit side, their tariff structure is totally different, because once you employ the doctor you now also bill for the services of the doctor, the hospital tariffs and the professional fees are put together into one pool of money, and then you pay the doctors a salary, but employment has advantages as well as disadvantages, from a clinical and from a business perspective, but  we believe there are more advantages that we’ve seen, and we actually feel quite positive about the model in Dubai."


    "In an ideal world we would like to employ doctors, in an ideal world we would like to train doctors. "


    "....because of the structure of our regulatory environment which does not allow hospitals to employ doctors and this is an issue we think is severely problematic and should be addressed."


    So where are we going then? 

    As you can see, there are a few varying opinions and rulings in regards to this important issue.  The final report from the Health Market Inquiry will take a further step towards clarifying the corporate employment situation in South Africa.  I am of the opinion that all we need to do as Healthcare Professionals to allow corporate employment / involvement / interference / ownership to become a reality, is to do nothing.  If you are concerned, raise this with you Association or Society, raise it with the HPCSA, raise it with the Competition Commission, raise the awareness and have the debate. 

    The Private Healthcare environment of tomorrow is going to be very different to the one we are used to. That is where we are going!

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