Liz Still, editor of the 2019 Healthcare Edition in South Africa spoke to Alignd about the current state of the healthcare sector in the country and how Alignd’s business proposition fits into it.
Alignd: You are in the process of completing the 2019 edition of Healthcare Edition in South Africa. How would you summarise the most critical aspects facing the sector at present?
Still: The cost of healthcare is currently a major issue in both the public private sectors in South Africa. Recently released figures from SARS showed that tax revenue growth was less than GDP growth in 2017/18. In addition, the contribution of VAT, measured as a percentage of total revenue collected, declined for the third year in a row, showing an economy under enormous strain. This all translates to a government with less to spend against the backdrop of a growing demand for health services.
There are also enormous challenges in the private sector. The picture painted by the Competition Commission’s Health Market Inquiry’s provisional report is one of key stakeholders either pulling in different directions or fighting to maintain entrenched positions. The Department of Health has not met its regulatory obligations to update PMBs and the Health Professions Council of South Africa has been rigorous in defending out-dated rules about how and where doctors can or can’t work. Medical schemes funders are battling with well-meaning but ill-conceived laws, an aging membership base and supply induced demand.
Doctors have lost their autonomy and are frustrated at having to motivate for care on behalf of patients, being micro-managed, untrusted and reduced to following narrowly defined treatment protocols. Some argue that this is the logical outcome of a fee-for-service environment.
There is an unacceptably high range of outcomes between provinces in the public sector. In the private sector, there is not data in the public domain that ranks health outcomes between medical schemes. Statistics show that medical scheme members are using health services more, but that they do not have any way of figuring out whether or not they are getting value for money from either funders or providers of care.
There is deep scepticism of the proposed single-payer NHI policy (for both right and wrong reasons) from critics within government as well as in the broader health community. There seems to be an unbridgeable divide between creating greater access to care and the real cost of care.
Alignd: How does the model proposed by Alignd play into these aspects?
Still: The launch of the model proposed by Alignd has been perfectly timed. The Health Market Inquiry has come out strongly in favour of experimenting with alternative reimbursement payment, prodding the Health Professions Council of South Africa to become more solution orientated.
There is new pressure on medical schemes to find ways to give patients/ members greater agency and to find patient-centric solutions that provide physical, emotional and spiritual care. Nowhere is this more required than in the palliative end of life time. Historically, the financial cost of end of life care has been very high; it is estimated that 43% of South African die in hospitals and 22% die at home.
It is also characterised by too-little communication about the patient’s priorities and fraught with ethical dilemmas on when to switch away from curative care to pain relief. The taboos around talking about death, as well as resource constraints have prevented funders from designing much needed models of care aimed at offering comfort and dignity to the dying.
The Alignd model proposes that a multi-disciplinary team of professionals is allocated to a patient nearing the end of life, to support both the patient and his or her family in a home or hospice setting. Logically, a multi-disciplinary team which includes a palliative care doctor, a palliative trained nurse, a social worker and a spiritual carer could be both more clinically effective and more cost effective than contracting only with a general practitioner.
Working on a global fee basis, the health professionals in the Alignd team would be mandated to provide care in the best interest of the patient. From a funding point of view, such a model would be well equipped to reduce unplanned hospital admissions with the consent of the patient.
‘Value based care’ as a health model was first described by US-based Michael Porter and Elizabeth Teisberg about ten years ago. But although the merits of this approach were recognised, health organisations around the world struggled with the practicalities of putting it into practice because the necessary enabling technology platforms were too expensive.
“I believe the Alignd team is uniquely positioned to embark on this project”
Social media-type apps have changed that. Fit-for-purpose software was designed for Alignd to allow for a patient’s data, medical records, images, pathology results and record of consultations to be available to the pre-selected team appointed with caring for the patient. The electronic record allows all members of the team to be up to date at all times without being physically present. This medical ‘conversation’ can then be used to ensure maximum support for the patient as well as serve as a record of advice and treatment and as the basis for billing.
Alignd: Do you foresee that increased collaboration between medical schemes, providers and patients will characterise South Africa’s healthcare provision in the future?
Still: Yes.
Alignd: What role do you see technology playing in bridging the disparities within the healthcare sector i.e rural vs. urban and private vs. public sectors?
Still: It will be really exciting to see how technology is developed and used to improve access to care. The technology pioneered by Alignd can be used ensure that specialist medical skills, which may be physically based in urban centres will be accessible to patients in rural areas. This could improve access to quality care in both a geographic sense and a financial sense. Obviously this model cannot be the answer to all medical treatment, but it could go a long way with treating chronic conditions like tuberculosis and HIV/Aids as well as non-communicable lifestyle diseases like diabetes.
Alignd: Any others?
Still: I believe the Alignd team is uniquely positioned to embark on this project. As individuals, the founder her partners have experience of and insight into the current private health sector and have launched their value based offering where it is most urgently needed. The proposed model looks simple from the outside, but has been designed to best align the interests of all parties in a way that saves money, and yet is more compassionate and sustainable.
