Charmaine Pailman Managing Director – Primary care

South African review - Primary care operating review

Our business

Our well established brands include a national footprint of 107 Medicross and Prime Cure Medical and Dental Health Centres. These offer comprehensive primary healthcare services delivered by 677 independent general practitioners and dentists.

Our centres also provide pathology and radiology services, day theatres and emergency services, and include 41 Pharmacross retail pharmacies. A range of ancillary health services are provided by dieticians, physiotherapists and optometrists. In addition, the division provides travel advisory and travel medicine services from 12 Netcare Travel Clinics.

Over the past twelve years the Prime Cure business has grown into a leading managed care organisation. Our contracted provider network has enabled medical schemes to offer benefit options to the previously uninsured lives, from primary to full risk cover. This has been vital in extending access to affordable quality healthcare to lower income groups.

Our contracted designated service provider network includes 5 099 doctors, dentists and optometrists, 1 266 pharmacies, 24 Prime Cure clinics, various provincial hospitals, and 270 private hospitals. Prime Cure is well positioned to leverage off our risk management competencies and provider relationships to extend our market leadership.

The Prime Cure Wellness brand provides occupational health, employee wellness, travel advisory and HIV services to 35 corporate clients nationwide. We are also providing these services to an international organisation with projects in ten African countries.

The year in review

Revenue increased by 10.8% to R1 513 million (2008: R1 365 million) aided mainly by a 10.7% increase in the Reference Price List (RPL), additional Medicross clinics and the expansion of the managed care and risk management services.

EBITDA for the division decreased to a loss of R24 million (2008: R4 million profit). Results were adversely impacted by underwriting and debt provisions from the prior year and changes to the division’s organisational structure. As previously communicated, the remedial programme to address the underperformance of the business continues.

Medicross and Prime Cure Medicentres

The swine flu epidemic resulted in higher patient volumes in all centres across the country and prolonged the increased seasonal activity associated with the winter months.

Our partnership with Edcon continued to provide an effective means to extend access to healthcare, with Edgars’ cardholders able to use their card facilities at Medicross Medicentres for their healthcare needs.

Prime Cure Managed Care Services

Prime Cure continued to expand its managed care and risk management services into the previously uninsured segment of the South African healthcare market, recording growth of 9.0% to 256 243 capitated lives.

Growth in managed care lives

Prime Cure matches the footprint of our providers to the footprint of our members on a regular basis, to ensure that our resource distribution is optimised and our network can provide comprehensive access, even in the most remote areas of the country.

The Clinical Advisory Board provides clinical governance oversight in the development of clinical protocols and pathways, including the 26 Chronic Disease List conditions published by the Council for Medical Schemes.

Prime Cure Wellness

Prime Cure Wellness services are delivered through on-site Occupational Health Clinics in a number of sectors. We have extended this to the construction sector with off-site services through our clinic network. The services provided to our international client have been extended to include Mozambique.

More than 5 000 employees across 10 African countries are provided with material on health education in English, French and Portuguese, annual health screenings and health risk assessments, as well as disease management of HIV/Aids, Malaria and Tuberculosis. These services are provided through locally contracted medical practitioners or referrals to appropriate public health services, depending upon the country.

Prime Cure Wellness provided HIV disease management to 19 medical schemes through an independent call centre facility and a network of 1 300 doctors, as part of the main Prime Cure network. HIV care and treatment was also provided to 4 500 patients in the Free State through a provincial treatment programme that was donor funded. We were also involved in an extensive voluntary counselling and testing (VCT) programme which has been conducted in a number of organisations, with more than 25 000 VCT consultations performed.

Prospects

Primary care has reviewed its businesses to ensure sustainability and growth in 2010. We have started upgrading clinic infrastructure which will continue in phases. Our initiative to improve access to travel advisory services will be strengthened by training ten professional nurses in travel medicine in 2010.

In our managed care business, extending benefits to low income earners in sectors such as mining are presenting new growth opportunities. These should support schemes in growing their membership base and support Prime Cure in extending healthcare delivery.

Prime Cure has extensive experience in both clinical risk management and primary care service delivery. This positions us well as a strong partner in primary healthcare delivery as envisioned in the government’s programme of action for health reform. The scarcity of critical skills in nursing, pharmacy and dentistry, and the challenge presented by the increasing age profile of general practitioners, remains the focus of Netcare’s human resources development plans. We will continue to mitigate these risks with ongoing investments in training
and development.

Medicross and Prime Cure Medicentres, as the largest national network of private primary care clinics, deliver high volume quality primary healthcare in urban and peri-urban settings. We plan to optimise growth to ensure our business continues to deliver quality while expanding to accommodate higher volumes.