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AGENDA
• Welcome & Introduction - Prof Franco Guidozzi
• GSK Overview - Sue King
• Proposed Integration of SASOG & GMG Services - Dr Chris Archer
• Healthcare Analysis - Casper Venter
• Malpractice Insurance- Paul Lewis
• Proposal – The way forward
OBJECTIVES
• New legislative and economic threats facing Gynaecology & Obstetrics / Private Healthcare
• Unify Gynaecology & Obstetrics in South Africa under auspices of SASOG
• Improved Service Delivery contracted by SASOG to - GMG
- HealthMan
- E2 Solutions
- Other
1.Historical Background
Analysis
Board of Directors
Membership
CEOSecretary General
Coding
Legal & Ethics
Private Practice
PPC
Oncology
SPPC GPPPC
Chair
3 Consulting
3 Surgeons
1 Pathology
Anaesthetics
SAMA STRUCTURE
Historical Background Analysis
SASOG
• Representative Association
• Approx. 500 Members
• Focus on - Academic
- Ethics
- Medico Legal
Historical Background Analysis
GMG
• Before SHCJV
• Formation of GMG
• GMG representation on SASOG
• SASOG representation on GMG
• SAMA representation
Gynaecology Management Group
• 10 years old
• Structured as a public company
• Functions as a Managed Service Organization (MSO)
• Membership of 250
• Funding from Member contributions and pharmaceutical sponsorships
Why the need for change?
• Enormous challenges & Threats– Appropriate response from Private Practice– Cannot leave it to SAMA
• Unity in the Gynaecology Community• GMG will continue – no debt• Better representation for O & G• Unfair burden on GMG members• Limited funding limits effectiveness• Need to employ professional consultants
Reforms originating from Government – objectives
Enabling legislation nearly complete
Ensuring health care services for all
Ensuring equity in the delivery of health care services
Move to an integrated National Health System –
Social Health Insurance for the future
Public Private Partnership initiatives are essential
Government Initiatives - Legislative
Private PracticeKey Legislative and other Issues Facing Private
Practice
• Medical Schemes Act of 1998• National Health Reference Price List 2007• Risk Equalisation Fund 2007• Circular 8 of 2006 to be implemented 2008• Management of PMBs, CDLs, DSPs• GEMS, LIMS, REF• Basic Benefit Package• Amendments to Health Professions Act• Increased Malpractice insurance costs• Increased Litigation• Hospitals taking control• Lack of new students specialising• NHRPL Processes• Premier Plan• DSP arrangement
SASOG COUNCIL
Executive CommitteePresident, Secretary, Treasurer,
GMG Rep, Academic Rep, Medicolegal
SecretariatSecretary, Academic, GMG Academic/Ethics
Finance CommitteeTreasurer, Academic, GMG, HealthMan
Private Practice (GMG)
Sub- Groups & DoH
SAMA & Medical Aids & DoH
Medico Legal
PROPOSED FEE STRUCTURE FOR MEMBERS
1800 – Full-time Private Practice
1200 – 1st & 2nd year Full-time Private Practice
1200 – Academic + RWOPS
450 – Full-time Academic
100 – Registrars
The Cost/benefit Relationship
Costs:
– GMG R2400
– SASOG R360
GMG Value add:
– R15,638 per month
– 651% return on investment
6. Healthcare AnalysisGynaecology in Perspective
Government initiatives – LegislativeFunding Issues – NHRPL 2007
ECONOMICS OF HEALTHCARE
2000 – R393
0
100
200
300
400
500
600
700
Mil
lio
n
2000 2001 2002 2003 2004 2005
Gynaecology Payout
2001 – R479 2002 – R533 2003 – R568
2004 – R614 Average – 15.52% p.a.2005 – R698
ECONOMICS OF HEALTHCARE
1997 – R20 254 968 1998 – R23 669 446 1999 – R28 747 153 2000 – R31 159 571
1997 – 2005 = 168% Increase (20.94% p.a)
0
10
20
30
40
50
60
mil
lio
n
1997 1998 1999 2000 2001 2002 2003 2004 2005
Medical Scheme Contributions
2001 – R36 977 784 2002 – R43 238 412 2003 – R48 635 737 2004 – R52 210 917
2005 – R54 192 476
0
1000
2000
3000
4000
5000
6000
7000
8000
2001 2002 2003 2004 2005
Admin Expenses
MedicalSpecialists
Clinical SupportSpecialists
Bil
lion
Economics of Health Care 2001 - 2005
Admin Expenses 14.36%
Medical Specialists 12.74%
Clinical Support 13.96%
Medical Specialists
0
100
200
300
400
500
600
700
2005 2004 2003 2002
Gynaecologists
OrthopaedicsSurgeonsPhysicians
Surgeons
Ophthalmologists
Paediatricians
Cardiologists
Otorhinolaryngologists
R/
Mil
lio
n
Year
Economics of HealthcareBENEFIT PAYOUT (R’000)
R 0
R 2,000
R 4,000
R 6,000
R 8,000
R 10,000
R 12,000R 14,000
R 16,000
R 18,000
Hospital Pharmaceutical
2000
2001
2002
2003
2004
2005
Hospital Increase - 95.73% - Average 19.15%
Pharmaceutical Increase - 15.53% - Average 3.12%
Pharmaceutical 2004 – 2005 - (-9.72%)
MEDICAL SCHEME Financial Review – Premium Income 2005
Discovery Health
Bonitas
Medihelp
Polmed
Medshield
Discovery HealthR14,760 millionBonitas
R3,748 million
Medihelp R2,658 million
PolmedR2,697 million
MedshieldR1,272million
Total: R25,135 million - 46.4%
ECONOMICS OF HEALTHCARE
IMPACT OF CIRCULAR 8 OF 2006
Non-PMB hospital & other common benefits
PMB Benefits
Option 1Option 2
Option 3Supplementary
Benefits
Common Benefits
RAND CONVERSION FACTOR (O&G)
• Labour RCF: R9.20 p.m.(Based on R729 405 p.a.)
• Overhead RCF: R8.49 p.m.(Incl. equipment cost)
• ROI Rate R1.07 p.m.• Total RCF: R18.74• Total RCF (Vat Incl.) R21.38 x 30 minutes• 30 Minute Consult R641.60
NHRPL 2007
0123456789
1011121314151617181920212223
Pra
ctic
es
Overheads
100-150151-200201-250251-300301-350351-400401-450451-500501-550551-600601<
Gynaecology
Overhead Costs
Staff Costs R309,873
Premises R51,151
Administration R129,223
Financial/Insurance R104,812
Other R52,417
Equipment/Fittings R84,077
Total: R731,553
Gynaecology
SURGICAL Rand Conversion Factor (Incl. VAT)
RENT 19.54GYNAECOLOGY 21.40OPHTHALMOLOGY 24.26UROLOGY 19.11NEUROSURGERY 20.28ORTHOPAEDICS 22.38(AVERAGE) 21.16
NON-SURGICALPHYSICIANS 19.06PAEDIATRICS 19.49PSYCHIATRY 17.00(AVERAGE) 18.52
SPECIALIST GROUPS RAND CONVERSION FACTOR
TARIFFS – THE WAY FORWARD
• Awaiting changes to the National Health Act – submissions by 28 February 2007
• Chris Archer to re-do coding structure- logical/anatomical sequence- assign time- assign post-op time- assign complexity
• Obtain hospital data• Cost studies to be re-done?• Review equipment utilisation
Service Offering to Members
• Academic
• Ethical
• CPD
• Medico Legal
• Healthcare Interactions
• Communication
• Commercial
Service Offering to MembersHealthCare Interactions
• HealthMan/GMG interacts and facilitates between various stakeholders in the health care market: - Private practitioners- Regional & National IPAs- SAMA & various Statutory Bodies- Medical Schemes- Administrators- Managed Care Organisations
• Summary of Key offerings- Coding & relative value units- Practice costs & tariffs- PMB disputes & resolution- ICD10 coding structures
Service Offering to MembersCommercial Offerings
HealthMan has established relations with a number of alliance partners that make their services available at preferential tariffs:
• Alexander Forbes (Malpractice)• Citadel (Wealth Preservation)• Prosper Financial Services (Investments, Life & Risk Insurance &
Employee Benefits)• Medigro (Short Term Insurance)• Sanlam (Bond Finance)• Wesbank (Motor Vehicle Finance)• VICIFIN (Bond Originator & Commercial Finance)• Absa (Credit card terminals)• NuDebt (Debt collection via ACB’s)• Payroll service• HealthFocus Practice Management system
Service Offering
Communications• Website
– Design / build, maintain, host and secure – see next slide
• Bulk E-mail – with auto responses• Bulk SMS service• Outcome based registers• Prescription pad facilitation• Internet Access
– Dial up / ADSL
• Electronic Journals