Healthcare innovators have historically faced obstacles, including outdated regulations, constrained funding, and limited support from medical schemes. The HMI report sheds light on significant regulatory barriers that impede healthcare innovation, particularly restrictive practices around multidisciplinary group practices and the employment of doctors. These challenges necessitate robust regulatory reform to cultivate an environment conducive to innovative care models.
The recent amendments by the Health Professions Council of South Africa (HPCSA) herald a shift towards more integrated and innovative healthcare delivery, giving hope to a growing number of persistent innovators working on the fringes of the private healthcare sector. The alignment of HPCSA regulations with the vision of the Health Market Inquiry (HMI) represents a decisive moment for the South African healthcare system. However, for this vision to be fully realized, medical schemes must step up as leaders in healthcare innovation, moving beyond mere compliance to become active proponents of change.
HMI Report: 2019
“Current regulation of practitioners through the Health Professionals Council, in particular on fee-sharing, multidisciplinary group practices, and employment of doctors, has significantly inhibited the evolution of innovative and integrated models of care… What is increasingly becoming the standard of care internationally – multidisciplinary group practice with a range of reimbursement models – is undeveloped and discouraged at worst, or made difficult at best, by fear of sanction by the HPCSA.”
Some provider organizations have taken the lead
Fortunately, within the South African context, there are esteemed innovators who have demonstrated unwavering dedication in the face of uncertainty. These exceptional individuals, representing diverse fields such as population medicine, palliative care, and the hospital-at-home sector, are poised to make further commitments and wholeheartedly embrace multidisciplinary practices. It is imperative that these trailblazers be duly recognized and supported as invaluable contributors to advancing the nation’s pursuit of accessible, high-quality healthcare.
Medical Schemes must play their part
The effective implementation of healthcare innovations relies heavily on the proactive involvement of medical schemes and their regulatory body, the Council for Medical Schemes. In order to promote and mainstream the adoption of multidisciplinary practices, it is crucial for the Council to introduce necessary amendments to its regulations. These amendments will enable medical schemes to make changes to their tariff codes, facilitating the accommodation of multidisciplinary teams. While it is important to exercise caution, we firmly believe that with the abundance of local expertise and knowledge, the adoption of innovative models can be expedited without unnecessary delay. By assuming a leadership role and wholeheartedly supporting multidisciplinary practices and value-based care models, medical schemes have a unique opportunity to make significant contributions to the advancement of South Africa’s healthcare system, ensuring their continued relevance in an uncertain future.
Conclusion
The HPCSA’s regulatory update, aligning with the HMI’s recommendations, is a pivotal milestone towards universal healthcare. However, this journey demands more than just adherence to regulations; it requires leadership and proactive involvement from all stakeholders, particularly medical schemes. Their influential role in shaping South Africa’s healthcare future is undeniable. Moving forward, a collaborative approach is essential to develop a healthcare system that is innovative, integrated, and universally accessible.
To see real progress, we propose that medical schemes undertake the following steps to expedite the evaluation and contracting of innovative healthcare models, and to nurture the development of new models:
- Perform comprehensive due diligence on innovative healthcare models to understand their impact on healthcare delivery and outcomes.
- Maintain open communication channels with regulators like the HPCSA to stay abreast of and genuinely contribute to future regulatory developments and recommendations.
- Develop a strategic plan to adopt and support existing multidisciplinary practices and value-based care models, allocating necessary resources for their further development and growth.
- Collaborate with fellow medical schemes, innovators, and stakeholders to exchange best practices, experiences, and insights on healthcare innovation.
- Develop the monitoring framework and metrics to evaluate the progress of implemented innovative models.
Through these actions, medical schemes can affirm their leadership in healthcare innovation, making significant contributions to shaping a more accessible and high-quality healthcare system for all South Africans.
Dr Howard P Manyonga is the CEO of Network One Health, a practice management company focused on women’s health and maternity. You can engage with him via www.networkonehealth.co.za or by email at howard@networkonehealth.co.za.