Archive for the ‘Latest Events’ Category

‘NHI will be an unmitigated disaster’

Sunday, September 2nd, 2018


“Despite its proven incompetence at managing public service organisations, the government is determined to create a vast centralised healthcare system. Instead of failing only some South Africans, as it does now, government healthcare will soon fail all South Africans,” wrote Ivo Vegter in Daily Maverick; 27 August 2018.

“The government keeps proving that it is incapable of running large organisations. South African Airways, Eskom, Transnet, the Post Office, the Passenger Rail Agency of South Africa, Portnet, and a host of other state-owned enterprises are beset with critical problems.

“This reality has not, however, given government officials any pause in forging ahead with a proposed National Health Insurance (NHI) scheme.


“Minister of Health, Aaron Motsoaledi, is sure the government is capable of running universal healthcare, but the primary government website,, on which these bills are supposed to be available, was down and returning '502: Bad Gateway' errors at the time of writing.


"Almost no aspect of healthcare will remain outside the centralised control of the NHI Fund. Its scale and complexity will be simply enormous. This vast new bureaucracy will have power to contract for and procure virtually all medical products and services in the country.

“Such a bureaucracy will likely employ hundreds of thousands of people, and far from reducing costs, will layer additional costs on top of existing private and public healthcare spending. It will inevitably be inefficient, as government bureaucracies always are, and will present significant new opportunities for patronage and corruption,” wrote Vegter.


Practitioners likely to leave - study


Health practitioners in South Africa are very sceptical about government’s proposed National Health Insurance (NHI) plan, with many considering migrating to other countries if the ambitious project is implemented - according to a report released by trade union Solidarity.

Nicolien Welthagen, a senior researcher at the Solidarity Research Institute, said the research found that practitioners feel there has not been sufficient consultation with them on the government’s plans to implement the NHI.

72,6% of practitioners indicated that they have not been consulted during the process, while only 38,8% of general practitioners feel that they have sufficient knowledge of the NHI.


More than 80% of healthcare workers believe that health practitioners will leave SA if government steams ahead with the roll-out of the NHI and 81,7% of the respondents indicated that they believe the NHI will destabilise the health sector.

Solidarity cautioned that the concern about healthcare in SA, in light of the NHI, must not be regarded lightly.

This was the reason why Solidarity Occupational Guild for Healthcare Practitioners organised “a crisis summit” involving experts from the healthcare environment and economists.

According to Dirk Hermann, chief operations officer of Solidarity, healthcare practitioners now need support.


NHI will ‘nationalise’ healthcare

The proposed NHI legislation will effectively lead to the nationalisation of health services if doctors and other providers are forced to contract to the NHI - Michael Settas (Free Market Foundation) a consultant specialising in the health market industry at a media briefing in Sandton on 15 August. While universal health coverage is a laudable objective, the need for an NHI is questionable, as South Africa’s spending on healthcare is already high, and the public service should be improved to deliver better care. 




MWEB filters our emails

Saturday, March 17th, 2018



Please be aware that most members with or affiliated addresses (iafrica, worldonline, etc) do not receive
SASES emails.

These are filtered out by the Mweb servers.We believe our emails supply valuable information to you.
We have approached Mweb who are unwilling to do anything about this.The way around this is to add our address to your 'allowed list' on your email client or mark the email as "not junk".

This Mweb guide should explain how to do this.
Alternatively request MWEB not to block our emails  (sent via mailchimp).


If you also have a non Mweb email address, let us know and we will change your contact details.




Update on SASES and Bariatric Surgery

Thursday, November 23rd, 2017


Dear Members


The SASES Exco has been reviewing the position of bariatric and metabolic surgery in South Africa with the view to supporting this very necessary surgery.

From the outset the SASES Exco has undertaken to drive bariatric and metabolic surgery in the public sector and is excited to note the growth of metabolic surgery in the University of Stellenbosch; more recently New Somerset Hospital in Cape Town, the Steve Biko Academic Hospital in Pretoria and Sefako Makgatho Health Sciences University in Pretoria.


On the private sector front to date the only route to financing through medical aids has been to have fully accredited surgeons doing the procedure. This not only entails a fully accredited surgeon but more importantly the whole centre and support staff. One understands full well why the medical aids will only deal with accredited surgeons as it is an operation which can have potentially large financial consequences if not done properly.


Aquilo with Proventi are now in a position to offer a second accreditation model to the South African private surgeon. To date the only accreditation system has been through SASSO under the guidance of Prof Tessa van der Merwe and her team but with Aquilo and Proventi, who bring to the party a huge international experience in bariatric surgery, the South African surgeon will now have choices as to whom he or she approaches for accreditation.


As a Society we have evaluated the international accreditation offered by Proventi and confirm that, in terms of quality and standing, it is on par with the local SASSO accreditation. We are excited that the surgeon now has more choice. We believe that this will open up the field wider for more surgeons to be accredited, be it either through Aquilo/Proventi or SASSO, to the benefit of patients in the private sector.


Kind regards

Dick Brombacher





SASES 2018 Meeting Announcement

Thursday, November 16th, 2017

13 to 16 September
Vineyard Hotel, Cape Town


At our Exco meeting held on 28 October 2017 a decision was taken that we will again host a SASES Stand Alone meeting in 2018. The choice of venue has been largely dictated by the new Eucomed regulations which take effect in January 2018.

The Vineyard Hotel is a stunning venue which will again allow the interaction over braais, dinners, et al which we have enjoyed at our past meetings and we have the full conference centre dedicated only to the SASES meeting.

Currently the invitations are going out to international visitors to attend. We will keep you posted on the list of visitors who will be sharing their experiences and lectures with us but in the meantime Prof Eugenio Panieri is hard at working putting together the academic programme.

As to the academic programme I would to take this opportunity to ask you, the Membership, to consider topics you would particularly like on the programme and to let Eugenio Panieri - - have these by return email so that these can be incorporated into the programme so that your wishes are catered to.

Looking forward to another great meeting again being managed by Denise Kemp and her team from Eastern Sun Events.


Dick Brombacher



Update on your society’s activities since Port Elizabeth ASSA/SAGES

Sunday, October 15th, 2017

9 October 2017

President’s Report



Dear Membership




As we have entered the final quarter of 2017 it is fitting that you, the Membership, have an update on what your Society – SASES is doing for you and for endoscopic surgery.


  1. Fellowships

The Fellowships for the current year have been awarded.  The fellows are either in the process of leaving or have left for Germany, Amsterdam or Belgium.  The new Fellowships will be advertised in January 2018 together with the two HIG Fellowships.


We as an Exco get feedback about the adjudication process in awarding Fellowships.  Martin Brand – Exco member in charge of Fellowships – and I met with the member who had concerns and it has been a learning process for both parties.  We will look at a few aspects of the adjudications system and I think the member who brought these concerns to our attention – for which we are really grateful – is reassured that the system is a well run system.


  1. Interaction with Medical Aids

The laparoscopic appendectomy evaluation process is ongoing with Medscheme.  Medscheme have approached us for the practice numbers and names of our members – it might well be that based on the results to date they will limit the laparoscopic appendectomies to SASES and Surgicom members only – another good reason to be a member of this Society.


  1. Development of Minimal Access Surgery on the Academic Front

The Fellowship which has been run by Prof Zach Koto at Sefako Makgatho Health Sciences University is now into its third round.  The Fellowship has now been recognised by the College of Surgeons and will probably become a formal Fellowship to which we hope to attach bariatric surgery.


We were approached by individual members of the Society as to the future of bariatric surgery as well as concern from industry.  The concerns were that there are two few bariatric surgeries being done per year for the population size in South Africa and its needs.  One recognises that bariatric surgery is possibly no longer the right term and one should refer to metabolic surgery.  Because of these concerns the following has happened:

  • A start-up meeting with the Heads of Department, Zach Koto and myself at the start of the recent ASSA/SAGES meeting in Port Elizabeth.
  • A meeting with Industry in Johannesburg this Wednesday evening with Prof Zach Koto and myself.


  1. Professor Zach Koto

It gives me great pleasure to announce to the Membership that Zach Koto, a valued member of the SASES Exco and a driving force behind the MAS Fellowship and bariatric surgery’s re-evaluation has very deservedly been elected to the position of President of the College of Surgeons, South Africa – Zach, on behalf of all the Membership a heartfelt congratulations on this well deserved post.


  1. Stand Alone Meeting 2018

You the Membership had requested a Stand Alone meeting for 2018 – the thinking was to use the same venue because of the success we have had to date.  At the completion of the ASSA/SAGES meeting Denise Kemp and I wrote to all the sponsors who have supported us through the last two meetings to gauge their enthusiasm as well as discuss the choice of venue.


Their enthusiasm was overwhelming; the choice of venue however is proving problematic because of the European guidelines on corporate spending.  At the Exco meeting on 29 October 2017 we will debate whether to move ahead and see if there is enough support from the companies not aligned to the European chapter or whether a whole new venue needs to be looked at or combining with SAGES in Johannesburg next year.


  1. The Red Cross Training Centre

On a personal note I was fortunate enough to attend the 2 day Tim Rockall cadaver workshop at the Red Cross Children’s Training Centre on 14‑15 September 2017.  The course was over subscribed.  One left that course realising that the Centre offers world class courses in a first world centre in our very own country with delegates attending it not only from South Africa but also from Namibia.


Having now attended two courses at the Red Cross Children’s Training Centre in this calendar year I can only but encourage the Membership, old and young, advanced and starting in their laparoscopic career to attend these courses as it is only when you leave this course that you realise how much each one of us still has to and can learn on an individual basis.  The courses are a master class, the facility is superb and it really is for our Membership to appreciate what they have on their own doorstep and to use it.


  1. Interaction with Industry

As of this year we have introduced a system where the leaders of the large pharmaceutical groups are given an opportunity to join us at Exco for an hour on a Sunday morning (hard bench) to discuss their plans going forward re education and training and to discuss with us concerns and hear our concerns.  To date we have met with Leanne Wood from J&J in February 2017; Colin Atkinson from Medtronic in May 2017 and we will be meeting with Stacey Meyer the new general manager of J&J at our Exco on 29 October 2017.  These meetings certainly are very beneficial.  It takes away the marketing aspect and brings it down to a working meeting as we realise as an Exco we are very dependent on industry for financial support with training and they benefit from the direct one on one feedback with Exco who after all represents the endoscopic surgeons.


  1. Exco Elections

A reminder that 2018 will be a voting year.  If you feel that you would like to contribute to the Society by getting onto Exco please make sure that you do attend the AGM – venue still to be announced – towards the end of 2018 and become an active member of this dynamic Society as it moves forward into the next decade.


Wishing you all well.

Yours sincerely


Dick Brombacher




Online report

Laparoscopic Appendectomy Study, Medscheme

Tuesday, May 23rd, 2017

22 May 2017

The final analysis of our six-month study was completed by Medscheme.  Fedhealth has now agreed to allow all appendectomies to be done laparoscopically, by SASES surgeons, in any hospital until the end of 2017.  The usual co‑payments which applied to these patients previously, still apply but letters of motivation by the surgeon will no longer be required.
The only criteria to be met are that:

  1. The surgeon stays within the set basket fee of R3 950 for disposable surgical equipment;
  2. The following plans are excluded:
  • Blue Door Plus
  • Dynamic Hospital
  • Dynamic Saver
  1. Should a surgeon operate on a Fedhealth patient and be found to have used more than the basket fee allocated, they will be contacted through SASES for an explanation as to why the cost was higher than the allocated cost structure.

We certainly, as Exco, are very pleased with the progress being made on this study but remind the surgeons that the ball is now squarely in our court – stay within the costing and we might well see this extended by other Medical Aids in 2018.
Yours sincerely
Dick Brombacher


Wednesday, March 1st, 2017


After our Laparoscopic Appendectomy Pilot Study which admittedly produced very small numbers, Bonitas Medical Scheme, who as you know falls under the Medscheme umbrella – our partners in the Laparoscopic Appendicectomy Study - have agreed to allow all appendectomies to be done laparoscopically without any letters of motivation being required.


The only two T’s and C’s which apply are:

  1. The surgeon stays within the R3950 basket fee for disposables.
  2. The lowest Bonitas schemes – Primary, BonSave, BonFit and Bon Essential – patients will be responsible for a R2750 co-payment.


An exciting breakthrough after a rather small cohort of patients were entered into the Pilot Study – we hope other medical aids will follow.


I will keep you posted.


Kind regards


Dick Brombacher







Wednesday, March 1st, 2017


The pilot project for Laparoscopic Appendicectomies under the Medscheme umbrella came to an end on 31/12/2016.   


Medscheme have started to unbundle the data which shows the following:

  1. A very small cohort of patients collected into the data base.
  2. Of those collected only 33% of the surgeons involved stayed within the designated price for basket of re-usables.
  3. One surgeon – two cases – overshot the basket being well above R8 000 for re-usables per case.


 The way forward:

  1. As the Project Co-ordinator, I plan to contact the individuals involved to see if there are explanations for the overshoot on the basket price.
  2. I have suggested to Medscheme that if it was done in more hospitals – not just Netcare – with more of the Medscheme medical aids being involved there might be a bigger pool.
  3. If there were a bigger cohort we would get a better overview of surgeons’ usages.


One of the concerning features for the SASES Exco is that in spite of a huge amount of work, negotiation, and a basket price being established, only 33% of cases were kept within the limits.   

It has been the mission of this Exco and those before us who initiated this project to make minimal access surgery financially affordable and sustainable – based on these results it would appear that the bench mark set for us by the medical aids was not attained by the membership making it difficult to try and renegotiate further pilot projects unless we, the membership, show intent to reduce costs.


More information to you as results or progress comes to hand.



Dick Brombacher

President SASES





Wednesday, March 1st, 2017


When I became President of the Society I took a decision to attend the first available course at our much spoken about Surgical Skills Lab at the Red Cross Children’s War Memorial Hospital.  As you will know we as a Society have backed Prof Alp Numanoglu in its establishment and got permission from you at our AGM some two years back in Cape Town to help fund Mr Clive van Geems, the Co‑ordinator of the Centre, financially for the first year to see if it could become financially self-sustaining.  


I therefore took the opportunity to attend, on 17 and 18 February 2017, the Advanced Laparoscopic Suturing Course at the Surgical Skills Lab.  


I arrived with a sense fear that here the President of the Society was going to be attending what I thought was a basic suturing course and it certainly took some humility to enter as a delegate with what was to be a team of Senior Registrars and other consultants in both the private and public sector.


Having attended a Suturing Course some twelve years ago I was absolutely astounded by the quality and level of this course.  From the very first introductory talk to two days later taking an advanced suturing test based on the gynaecology model from Europe I was in awe of how much we individually can learn with a refresher course but also realise that this course is not aimed at the Registrar or the Trainee but rather us surgeons who have been in practice for years, possibly believe we need no further retraining but realised that we all can benefit from it – hugely.  


I will encourage you, as members, to travel down and attend when courses are offered because the benefit is immense.   


It remains for me to, on behalf of SASES and the Exco, thank both Prof Alp Numanoglu and Clive van Geems for the amazing work they are doing – to encourage you to use this world-class facility which has surgeons travelling from other parts of Africa to attend courses and yet it is on our door step for us to benefit from its use.  Please see website info.

Wishing you well in your surgical year ahead.




Dick Brombacher






IRR report on NHI describes government policy as catastrophic for SA healthcare

Thursday, January 12th, 2017


This report suggests that NHI will destroy private healthcare and result in a drastic deterioration in South African healthcare standards. It will cause loss of medical practitioner's autonomy and result in a huge inefficient bureacracy that is likely to be plagued by maladministration and corruption.

It is likely to result in increased emigration of healthcare personnel and even citizens who are dissatisfied with deteriorating standards of care. It is these wealthy south africans who actually fund the proposed NHI through increased taxation.

Increased government regulation and meddling has actually increased cost of healthcare insurance and made low cost health insurance unaffordable to lower income groups. Public hospital healthcare standards have deteriorated and resulted in a drastic increase in medical malpractice claims. PMB legislation has increased the cost of entry level medical insurance.

There are numerous proposals in this report that suggest better approaches and successful healthcare methods that have been used in other countries.  The public need to understand the great threat that NHI poses.


Read the full report:  NHI Risks lives for no good reason.pdf




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