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PROFESSIONAL ASSOCIATIONS AND THE NHI MARTIN SUSSMAN PRESIDENT SOUTH AFRICAN HEART ASSOCIATION

PROFESSIONAL ASSOCIATIONS AND THE NHI MARTIN SUSSMAN PRESIDENT SOUTH AFRICAN HEART ASSOCIATION. NATIONAL HEALTH IN SA 1940’s.

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PROFESSIONAL ASSOCIATIONS AND THE NHI MARTIN SUSSMAN PRESIDENT SOUTH AFRICAN HEART ASSOCIATION

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  1. PROFESSIONAL ASSOCIATIONS AND THE NHI MARTIN SUSSMAN PRESIDENT SOUTH AFRICAN HEART ASSOCIATION

  2. NATIONAL HEALTH IN SA 1940’s • “...limited financial resources and vested interests- in the form of powerful medical professional associations or (in the case of South Africa) of provincial administrations-delayed, scaled down or reshaped the original reforming vision.” • Digby, A. (2008). ‘Vision and Vested Interests’: National Health Service Reform in South Africa and Britain during the 1940s and Beyond. Social History of Medicine, 21(3), 485-502.

  3. SOUTH AFRICAN HEART ASSOCIATION • What is SA Heart Association? • Why do I think professional bodies should be involved in developing a national health plan? • How does NHI relate to education and training? • Issues with current structures – can we improve them?

  4. S A HEART AND THE NHI • The South African Heart Association represents the majority of specialists and other health care workers involved in the cardiac health of our population. SA Heart was formed eleven years ago by the amalgamation of two cardiac societies- the South African Society of Cardiac Practitioners which represented the private sector, and the Southern African Cardiac Society which represented the “full-time” practitioners. We now represent both the public and private sectors comprehensively, with both having standing committees on our EXCO. We view amongst our roles the education of the public in cardiac health matters. Heart related conditions affect the health of many of our people in South Africa, and remain a major cause of morbidity and mortality amongst our people of all socio-economic classes. • Bearing this in mind, we feel we are well positioned to assist in formulating new policies in line with the NHI proposals as we understand them. We are therefore hoping to use this letter of introduction to the working committee as a platform upon which future consultative relations can be built.

  5. SA HEART MEMBERSHIP • CARDIOLOGISTS • SURGEONS • TECHNOLOGISTS • NURSES • INDUSTRY

  6. SPECIAL INTEREST GROUPS • SURGICAL • CASSA • SASCI • CISSA • PCSSA • LASSA • HeFSSA • BASIC SCIENCES GROUP

  7. SOCIETAL AFFILIATIONS • PASCAR • ESC • World Heart Association

  8. CURRENT PROJECTS • SHARE REGISTRY • TRAINING / EDUCATION WORKING GROUP • NHI INPUT

  9. SA HEART ASSOCIATION 2.    OBJECTIVES The objectives of the Association shall be: 2.1.  To promote and develop the life sciences pertaining to the cardiovascular system in health and disease. 2.2.  To promote good fellowship among those involved in the treatment of patients with cardiovascular disease or with research interests involving the cardiovascular  system. 2.3.  To represent, promote and protect the professional interests of cardiologists and cardiac surgeons. 2.4. To promote public welfare by education directed towards the prevention and treatment of diseases of the cardiovascular system. 2.5.  To take an active role in establishing and maintaining standards for quality cardiovascular health care delivery.

  10. WHY ME? WHY HERE? 7.6.  The function of the National Executive shall be to:    7.6.1.   Promote the objectives of the Association in keeping with its Constitution    7.6.2.   Act as the spokesperson on behalf of the Association.     7.6.3.   The President shall represent the Society at home and abroad, will chair meetings of the National executive, Council and preside over the Annual General Assembly and Annual Congress of the Association.

  11. WHY GET INVOLVED? • Current system not adequate • Education and training are priority in SA Heart • Critical shortage of cardiac specialists in SA • Cannot afford a medical ESCOM – must ensure supply. Load shedding? • Keep experts in SA – and in full-time practice • Bridge the divide • Positive contribution – clinical expertise, data, professional influence, commercial influence • Harness goodwill among members

  12. PRINCIPLES • Good primary health care requires good specialist training • Current system not adequate • Private too exclusive, state too inefficient • Planning must be exemplary • Get input from “experts” • Mistakes are VERY expensive

  13. KPMG SEPTEMBER 2010 No perfect system Great deal to learn from other models Many pitfalls to avoid No working model to copy “learn from everyone, copy no-one” Majority in favour of NHI

  14. COMMON MISCONCEPTIONS • Doctors against NHI • Private practitioners “fear” NHI

  15. WAY FORWARD WORKING TOGETHER

  16. MINISTERIAL ADVISORY COMMITTEE • No Specialist body representation

  17. Dr Aaron Motsoaledi • “...we actually encourage every single South African to engage on any policy matter put on the table by Government. We welcome all forms of engagement, as long as they contribute towards building our country and not destroy it.”

  18. Dr Aaron Motsoaledi • “Our first task towards implementation of the NHI is to massively overhaul the system at all levels and top on our list of priorities in this regard is quality improvement plan for public health care facilities” • “Within the next year we shall start a plan towards the establishment of closer PPPs in improving health facilities “

  19. S A HEART AND NHI • Example • Illustrate “lost opportunity or good decision making”? • Not meant as state facility thrashing

  20. Some Important Statistics (2006) • Population SA in 2006 47 850 700 • Population on medical aid SA 7 127 343 (15%) • Population without medical aid SA 40 723 357 (85%)

  21. CARDIOTHORACIC SURGEONS IN SA • Active registered CTS in SA -109 • State employed CTS SA - 38 (6 part time) • Number active training units in cardiothoracic surgery in SA- 7

  22. CTS SURGEON:POPULATION • Ratio CTS to Population in State practice in SA 1 : 1 000 000 • Ratio CTS to Population in Private practice SA 8 – 20: 1 000 000 • North European recommendation is 8 : 1 000 000

  23. CLINICAL SERVICE PROVISION – central SA • 300 thoracic operations in 416 239 privately insured population. (720 per million) • 190 thoracic operations in 4.2 million state patients. (45 per million).

  24. Morale amongst leadership in cardiothoracic surgery in SA is at an all time low. • Private hospitals aim to facilitate patient access to the doctor whilst state hospitals patently aim to prevent patients being treated. The immorality of this practice affects the morale across the whole of the health provision.

  25. CONSEQUENCES • The problems in medicine do, in a very real sense, continually feed the poverty cycle, thereby furthering the divides in our society. This directly fuels the fires of hopelessness, civil unrest and violence, as sick patients are excluded from proper health care and find themselves unable to work and unable to provide for their dependants.

  26. THUS……we could conclude…. • More of the same seems doomed • Need to get back senior assistance • Should change model • Need leadership, expertise, energy, collaboration

  27. PROPOSAL • 5 year plan, rewards within 2. • After 5 years – 800+ cases/year, train 1 registrar EVERY YEAR, flag-ship unit for hospital, University and Gauteng Health. Working model of PPP in health. Profitable.

  28. ROLE OF GAUTENG DOH • Continue to support CTS at current level • No interference or influence re-admin – staff, salaries, equipment, disposables etc • Transparency – financial, clinical audit

  29. ROLE OF UNIVERSITY • Administrative assistance as required • Academic input • Undergraduate and post-graduate teaching • Access to financial details

  30. ROLE OF CT CHIEF • Establish and maintain CTS clinical service • Raise necessary funding from donors • Employ necessary staff – medical, nursing, ancillary personel • Answerable to governing board

  31. BOARD OF GOVERNORS • Representation from – Govt, University, donors • Other medical and non-medical members • Health insurers, partners

  32. CLINICAL VISION • Increase number, quality of procedures • Train personel • Attract insured patients • Contracts with insurers • No discrimination between insured and state funded patients

  33. LOST OPPORTUNITY or GREAT INSIGHT? 2 weeks later university asked applicant to reconsider No word from Dept of Health

  34. CURRENT STRUCTURES • “Full- time” specialists • Chief surgeon told applicant to “just say you will”

  35. CONCLUSIONS • NHI has support amongst doctors • Consensus that change is needed • Consultative process imperative to maximise success – talk to right people! • “Give and take” attitude • PPP way forward • Three areas associations can help • Planning (data, expertise), Service provision (clinical,equipment, facilities, management), Education

  36. ARE FINANCES REALLY PROBLEM? • State health already funded by tax payers • Private is profitable • PPP – private efficiencies, public volumes • Move past irrational decision-making

  37. FLOYD LOOP 2009 “Practising doctors must lead and make decisions”

  38. SOUTH AFRICAN HEART ASSOCIATION

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