Broken

Last week the Board of Healthcare Blunders announced to the world that it is going to be more aggressive in representing its members. Having in the past compared the organisation to a jellyfish all I can say is that this is long overdue. If it does actually happen then my advice to the BHF is: pull a finger out, stop obsessing about payment in full for PMBs and campaign on behalf of your members based on a coherent strategy and vision that serves the interests of medical scheme members (the ones who pay all those billions of rands in contributions, not the trustees and administrators).

(Another article on the same press conference was titled “Harnessing the Power of Now“. When I read that I threw up in my mouth a little.)

BHF chair Dr Clarence Mini refers to an annus horribilis (stop sniggering – it’s spelt with a double n). The problems actually go back further than one year.

The industry’s excuse for a representative body been gutted by a decade of rulings by courts and competition authorities that haven’t gone its way and sapped it of any power it may once have held.

The industry hasn’t exactly stood up for itself in an effective manner. Every time there is criticism of the medical schemes industry the response is either “there are reasons why things are like this (but we can’t explain it to you)”, “it’s not us it’s them” or “we’re very very sorry”.

If you act like a doormat you will get trampled on.

Anyway, that is not what I wanted to talk about today. What I found much more interesting in the article was this comment by Dr Mini:

He described the attitude of the Council for Medical Schemes registrar, Dr Monwabisi Gantsho, as ‘confusing’. “One of our failures has been winning over the registrar and trying to understand where he wants to take things,” he said.

[…]

“We don’t understand. One of our problems in this past year is that we’ve tried very hard to understand how this registrar wants to take things forward. Our members are frustrated. We have good meetings with him and after that we get these vicious letters.” Dr Mini cited Circular 51 as an example, in which BHF members were threatened with punishment if they support its case.

“From our side, we endeavour to interact with him. We have nice meetings, but after that nothing seems to work out.

Dr Mini is not the only one confused by the behaviour of the registrar.

Now the C4MS has never distinguished itself as a regulator particularly bothered by anything as trivial as cold hard facts. It also doesn’t seem to appreciate the need for regulatory authorities to act in a consistent way. Who needs a well thought out strategy for regulating private healthcare funding when you can just fly be the seat of your pants, guided by your own notions of what is fair, appropriate and true?

In recent years the C4MS has, however, set new standards for ineptitude and this period has coincided with the appointment of Dr Monwabisi Gantsho as Registrar of Medical Schemes.

Coincidence?

Can I tell you a secret Dr Mini? Just between us – this isn’t for general consumption you understand? Even some of the people working for the Registrar have, in unguarded moments, admitted that they find his behaviour unpredictable. They will have meetings and discuss how the C4MS will respond to some industry matter and everybody in the room will come to an agreement. Then suddenly, out of the blue, they will see the Registrar being quoted in the press or publishing a circular saying the exact opposite.

How would you respond if some third-party challenged you about something your boss said that isn’t what you agreed internally? Remember when I compared the C4MS to Michael Scott? I think Dr Gantsho is, personality wise, closer to his replacement Robert California.

Now if you believe in a universe built on cause and effect then there must be some explanation for everything the man does, right? As far as I can work out there are three possible explanations.

The first we shall call the competence explanation. This is the explanation favoured by Hanlon’s Razor. Dr Gantsho comes from a medical background and for all I know he may be the very best doctor in the whole wide world. That does not mean that he is automatically qualified to oversee the private healthcare funding industry and like many political appointments (he was put there by the Minister of Health) he may just be out of his depth, not fully understanding the implications of his own actions.

The second possible explanation shall be known as the psychological explanation. Simply put it is a question of whether the Registrar is mentally unstable (or to use the proper medical term: “a loony”). I don’t know him well enough to give a diagnosis. In the end everyone is a little bit crazy.

Hi! I’m your friendly and supportive regulator

Finally we have malevolent conspiracy. The thinking goes: if a competent and sane person is put in a position of power over an industry and keeps saying and doing things that are hostile or even harms that industry then obviously he must be intent on destroying it. The extreme version of this theory states that he may even have been given the job with that very mission: to screw up private healthcare funding in South Africa to such an extent that NHI becomes the only way out.

These three explanations are not mutually exclusive. They can be combined in seven different ways, as illustrated by the following diagram:

How much each of the explanations apply may also vary. For example the Registrar may be somewhat competent and wishing to do the right thing but his medical background and history may preclude him from seeing medical schemes as anything other than the bastards who should pay doctors bills.

Whatever the answer the results have been the same: The relationship between the Registrar and the industry he is responsible for is damaged to the point of being dysfunctional.

I can’t count how many meetings I have been in, or how many conversations I have had, where someone who is responsible for a medical scheme (say a trustee or PO) has said something along the lines of “..so we looked at the situation and came to the conclusion that we should (sometimes even must) do X. But Council will never allow it so we can’t.”

How the hell did we get to this point? I cannot force myself to believe that the regulator would not allow a scheme to follow any course of action so long as it is legal, consistent with the principles enshrined in the Medical Schemes Act and based on solid evidence. Unless the regulator isn’t too clear on these issues…

Maybe the Registrar’s mercurial behaviour has simple caused the industry to behave like “a dog that’s been beat too much“. It is probably going to take years and years to repair the relationship between the industry and its regulator.

It may go much easier without Dr Gantsho.

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6 thoughts on “Broken

  1. The BHF is not going to win its case as they have it – they royally mesed up their arguement. So. John, we will all have to wait for soemone else to take it on and win for the industry. The whole thing is a mess though.

    The MoH (Minister of Health) waltzed into town with a big city attitude , full of enthusiasm and promise to clean up where Barbara Hogan left off. We waited with antici…pation …. As time went on he saw that the problem was, well, quite large. Hell he can’t even sort out the Eastern cape issue – doctors not paid!!! What next?? And so attention was turned to the hot political potato – NHI. So let’s take our attention off the ball and talk about NHI. Problem is that that story is not going too well so let’s do something else – but what? I know. Let’s ban smoking in your home. That should get everyone stomping around so that they hopefully forget about the mess that private healthcare funding is in and the public hospital mess and NHI and … and …

    Meanwhile, back at the ranch, Gungho is causing hayhem Nobody seems to know what his mandate is other than to seemingly destroy private healthcare funding. You say that the purpose is to drive folk into public hospitals but that doesn’t hang together. His pay in full cries are achieving the opposite.

    Just where is he coming from? Looking at it objectively, both the MoH and Gungho are doctors and they appear to be confused about their constituency. The doctors are the ones getting revved up about wanting more of the pie that is available. Has everyone lost sight of the fact that schemes take prices – they don’t make prices? So when he says pay in full the members get to bend over and look for the soap, again!

    But folks, just to make you feel better, when there are no medical schemes any more and we cannot afford private healthcare, we can always look forward to the public sector. Of course there may not be any doctors around by then but hey, who cares. The regulator does not appear to care. His job is to regulate the existing law not make law. The C4MS thinks that it is bigger than Parliament and that its circulars have legal effect. Policy is not law. Ask yourself this, Where is Pat Masobe now? Or Pat Matshitze? They waltzed into town, caused havoc and now. Where are they?

    Carry on the good work. Your style is very refershing and so on the money.

    1. Hi richard

      Thanks for the comment

      I don’t think the intention is to push medical scheme members into the public health system. At least not until they can find a way to lay their hands on medical scheme money first. However, if the private healthcare industry is in shambles then it become easier to say “see! you guys can’t manage yourselves so government has a moral obligation to intervene.”

      The above only applies if you subsribe to the conspiracy theory. It may just be that the “wisdom” that says that the healthcare part of the term “private healthcare funding’ means that doctors should be in change of the medical schemes industry is being exposed as a fallacy.

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