Medical Advisors Group Dr Johann Van Zyl Head: Private Practice Unit Objectives • Stimulate constructive debate • Pose fundamental questions • Raise controversies • Highlight concerns • What went wrong? • Highlight potential synergies • Way forward Questions • When is evidence evidence? • Can there be interpretation bias? • What does appropriate mean? • What is the difference between funding and clinical recommendations? • What is being funded? – Healthcare? – Diseases? – Benefits? Questions (Cont) • What should the priority be? – Patient care? – Financial status of the scheme? • Should there be funding priorities? • What are we talking about? – Managed healthcare? – Managed benefits? – Managed disease care? • Who should be the manager? Controversies • Benefits vs Clinical needs • Benefits vs Patient needs • Funding vs Clinical recommendations • Funding of Diseases vs Health • Evidence vs Evidence Concerns • Professional independence • Clinical autonomy • Clinical judgement • Doctor/patient relationships • Communication between doctor and patient • Recognition of expertise • Generalisation • Ethical rules • “Dual loyalties” What went wrong? • Poor communication • Lack of mutual understanding • Benefit designs • “Savings” approach What went wrong? • Poor communication • Lack of mutual understanding • Benefit designs • “Savings” approach Adversity Synergies • We are all professionals! • We should all be patient focussed • We are all concerned about the cost of healthcare • There is a will to work together • We are all SAMA members! Way forward • Create a platform for open and constructive debate • Establish a list of core issues • Replace the actuarial approach with a clinical approach, or at least a balanced approach • Engage rather than accuse! Conclusion • Relationships have been badly managed • Various perceptions have developed • We need to unite as a profession in order to address these • SAMA is committed to such a process For the sake of our patients! Thank you!
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