Services provided needed to be categorised. The Gauteng legislature’s committee on scrutiny of subordinate legislation (CSSL) has approved regulations which give effect to the annual adjustment fee of 4.9% on services payable by patients at provincial hospitals and for mortuary and ambulance services. Neither public nor private hospitals were being monitored for quality or price. Visit SA Government Coronavirus (COVID-19) website: https://sacoronavirus.co.za, PC Health: Briefing by the Hospital Association of South Africa (HASA) on their tariff structure setting and process, National Department of Health presentation, Hospital Association of South Africa presentation, Board of Healthcare Funders of Southern Africa presentation, BRRR: Budget Review & Recommendations Reports, Code of Conduct / MP Disclosure of Interests, Creative Commons Attribution 3.0 South Africa. He made the point that there was only one health system in South Africa. Dr Matlala felt it was incorrect to compare public and private hospital prices. There was a severe global shortage of nurses. Department of Health (Western Cape Government) Listen. Discovery Health believed the private sector to be a key strategic asset and thought that it added value to the value chain. The mere regulation of medicines alone was not good enough. Hospitals competed for specialists and attracted them through hi-tech medical facilities and service offerings. The fees appearing in the Schedule are applicable in respect of services rendered on or after 1 April 2015 and Exclude VAT.---Wp7.44 47..4 MN OLIPHANT, MP MINISTER OF LABOUR DATE. Agency nurses were employed where there were shortages of nurses. DA shadow health MEC Jack Bloom said the adjustments were not unreasonable, but it would be up to the province to ensure that they were applied correctly. In addition, tariffs are not indexed to costs and French hospitals may be subject to external measures. Ms E More (DA) asked the BHF what was meant by robust quality assurance. It must, however, be remembered that medical schemes were complex and that administrative costs formed a huge portion of costs. Dr Pillay stated that the Minister of Health had agreed that the public hospital sector had to improve. This publication provides an explanation of the tariffs charged in government hospitals. Individuals in most instances did not have a choice as to which private hospital was used, as the specialist would simply admit the patient to the hospital where s/he worked. Cost information should form the basis of the negotiations. Private hospitals demonstrated a large growth in their return on investment compared to the cost of their debt. He said that HASA had given the impression that it was denied the opportunity to make inputs, although the Department had stated the opposite. Members also discussed issues around the training of nurses, incentives for doctors in admitting patients to certain private hospitals and the profit motives, with the Committee expressing scepticism about the relationship between  doctors and the private hospitals where the worked. Claim costs remained stable from 2005 to 2008 but increased in 2009. Private hospitals had gotten rid of such individuals. Access to medical aid schemes was dictated by the incomes of individuals. Challenges for consideration include market concentration, the medical “arms race” (non-price competition) and detrimental relationships. The patients that private hospitals served were mostly insured. Medical scheme membership was closely linked to formal employment. Mr Waters asked CMS what impact the certificate of need had on the concentration of markets. Health-e News has spoken to a few Gauteng residents to hear their views on the increase. Finally, he noted that public sector hospitals did not have a tariff list that was made public, but it was available if needed. The amended regulations were presented by the Gauteng health department for approval by the committee and will come into effect ‪from Wednesday. When the facility is registered the Department of Health will issue the owner of the facility a certificate of registration, which needs to be renewed before 31 December each year. As of Tuesday, the number of pupils across Gauteng who have contracted Covid-19 is 58, while 188 educators have contracted the virus. One of the points made was that no private hospitals employed medical specialists. Dr Zokufa outlined the gaps in the South Africa healthcare system as the lack of robust quality assurance and assessment systems linked to cost, lack of robust health technology assessment, lack of meaningful peer review processes and inadequate regulatory controls to protect the consumer. Chairperson’s opening remarks If there was a commensurate reduction in medical scheme contribution rates, the average medical scheme beneficiary who paid R890 per month in 2009 (according to the Council for Medical Schemes) would only pay R63, or 7%, less per month. Mr D Kganare (COPE) asked HASA why the private hospitals could not break down their charges, stating that the main aim of private hospitals was profit. Pharmaceutical products at private hospitals had to be sold at the Single Exit Price (SEP), which was set by the Minister of Health. Profit was important in the private sector, whilst improvement in health status was critical for the public sector. Premium content from before 2019 is now available for everyone! He noted that it was a fact, in central bargaining, that persons often disagreed and asked what the solution if there was disagreement. The Chairperson stated that the Health Practitioners Council of South Africa monitored health professionals. She noted her own experiences, when admitted to a private hospital, that there had only been one professional nurse per ward. Tariffs structures in private hospitals HASA maintained that it was necessary to ask whether the prices were too high in relation to the input costs. Board of Healthcare Funders of Southern Africa, noted his concern that although, generally speaking, the funding side, or medical aid schemes, showed more transparency, there was a gap in the system in regard to providers, or private hospitals, since the only aspect that was controlled on that side was medicine pricing. In metropolitan areas it was found that doctors often worked in more than one private hospital. For over 19 years, Parimala Super Speciality Hospital has been synonymous with holistic and compassionate care. Another point was that medical aids negotiated with hospital groups on tariffs. The RPL was a reference list of costs. Public hospitals obtained pharmaceuticals at state tender prices, mooted to be between 50% and 70% cheaper than private sector prices. Individuals had different medical schemes to choose from, yet Discovery Health was one of the favourite choices. He noted that his presentation would explore cost trends, cost drivers and explain them by considering competition dynamics, private hospital behaviour and ownership. Mr G Lekgetho (ANC) stressed that something urgent needed to be done to close the gap. HASA claimed that no profits were being made, whereas the CMS showed that in 2009 there was a sharp increase in profits of private hospitals. Dr Humphrey Zokufa, Managing Director. The issue of how much it costs is then secondary,” said Kekana. He pointed out that the private hospital only made profit on 60% of the total hospital bill. The gist of the presentation was to explore cost trends, cost drivers and to explain them by considering competition dynamics, private hospital behaviour and ownership. Hospital costs were a key cost driver and the rising trend was important. If that was done, prices would come down. More blacks had been joining medical aids since 2007. 09'05/.50/5 This gazette is also available free online at www.gpwonline.co.za 4 No. He also pointed out that the private sector produced more nurses than government. HASA had consistently provided the Department with information and engaged in various processes initiated by the Department, which included the Reference Price List (RPL) process. The relationship between private hospitals and specialists was a consideration, given that specialists determined how long a patient stayed in hospital. He was of the view that it was necessary to have statutory powers to intervene, as currently CMS could not take action, and recommended that government must urgently close this gap, before the situation would reach catastrophic proportions. Government had conceded that it had made a mistake to close certain nursing schools. CMS had to look at cost containment, the governance of medical schemes and member access to benefits. When a member of a medical scheme had treatment at a private hospital the medical scheme only agreed to pay a certain percentage of the private hospital bill, with the patient having to pay the rest. The Department had received reports that doctors often times received perverse incentives. The private hospital industry trained more nurses than the public sector, and this too added to its cost pressure. Every private hospital or unattached operating theatre needs to be registered. If the assertion by BHF was correct that there was inadequate regulatory control, then she wondered how greater regulation would solve the problem. Members had received the impression that health was a commodity, and there was some question as to whether the interests of patients or shareholders came first. Members were given a breakdown of trends and statistics in the private health sector. Furthermore, she noted that soon a standards compliance office would be opened, and the issue of primary healthcare would be dealt with, and she asked also what the private sector’s view was on this. Ms Ngcobo then asked what the private sector felt about price negotiation. HASA maintained that it was necessary to ask whether the prices were too high in relation to the input costs. In 2009 the same newly built bed would cost R997 000. One of the points made was that no private hospitals employed medical specialists. The main cost drivers were hospitals and specialists. According to Archer, "ethical" tariffs should be at least 20% higher than "guideline" tariffs. Provincial health spokesperson Kwara Kekana said the idea that public services should not be paid for was a misconception. Tariff: A tariff is a tax imposed on imported goods and services. Two years previously, the auditing firm PriceWaterhouseCoopers had done such a presentation. Dr Pillay stated that there was no regulation on the certificate of need. Paying patients at public hospitals will from Wednesday pay an increased service fee for procedures at public hospitals. Doctors were independent practitioners, and HASA had no say in the fees that they charged. Government had to step in and protect its people. The private sector did not yet have training colleges but plans were in place for them. Non-health care costs had increased from 1998-2006, but had decreased since the intervention by the Council for Medical Schemes (CMS. The regulations give authorisation to the department to make adjustments to these fees annually to ensure it can generate enough revenue to meet the increasing demands of the health-care sector. HASA was at pains to explain or break down the costs structures charged by private hospitals, to correct what it thought was a misconception. He commented that the public sector should start looking at ways to improve services in order to attract people back to it. Inputs by other service providers were also ignored by the Department. Private hospitals demonstrated a large growth in their return on investment compared to the cost of their debt. Payments to private hospitals made up 33% of medical schemes’ gross contribution income of R84.8 billion for 2009. There was an erroneous perception that the private hospital industry was unwilling to engage with regards to pricing and tariffs. 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