How sick is SA healthcare? We're about to find out
After many delays, an enormous probe into the industry is about to be released. Here's what you can expect
If you find medical aid premiums very expensive or hospital bills overwhelming, you’ll find a crucial report being released next week very interesting.
On July 5, after four-and-a-half years, the Competition Commission’s Healthcare Market Inquiry (HMI) panel is expected to finally release its provisional findings on the reasons why consumers have to spend so much on private healthcare.
There were five full-time judges on the panel, which was headed by former Constitutional Court chief justice Sandile Ngobo.
Wits Professor Sharon Fonn and Dutch expert Cees van Gent, who was involved in a similar inquiry in the Netherlands, were also among the panelists.Why should you care?
The analysis includes 90% of all medical aid data over a five-year period, which the inquiry panel described as the “most comprehensive that has ever been compiled to explain private spend in healthcare”.
The report is also expected to explain why more and more is spent on healthcare, with an interim report released last December suggesting people getting sicker may be partly to blame. It noted people are having more surgery and spending more days in hospital for the same condition.
Inquiry director Clint Oellerman said the report will give “recommendations” regarding the competetiveness of the private sector.
What issues were discussed?
The hearings became a way for everyone to vent their unhappiness with the current private health system.
• The SA Medical Association, representing doctors, said medical aids were dictating treatment protocols and not allowing doctors to do what was best for patients;
• Consumers spoke of their battles to get medical aids to pay more;
• Medical aid administrator Discovery Health said doctors charged more for certain procedures when it was specified in law that a certain treatment had to be covered “in full”, no matter the cost;
• Discovery Health also pointed out problems with the law that medical schemes were forced to keep 25% of premiums in reserves. Discovery proposed some forced savings be used to pay for medical care;
• Radiologists rejected claims that doctors gave patients unnecessary tests in order to make a quick buck; and
• The Netcare hospital group said South Afrcia was very short of doctors.What was controversial?
Health Minister Aaron Motsoaledi commissioned a report by The World Health Organisation that found SA healthcare was very expensive compared to rest of the world and “unaffordable”.
However, hospital groups and Discovery Health objected to the findings. One criticism was that looking at whether private care was affordable for all South Africans, including unemployed people, was unfair.
The panel set aside a week to examine the issues, and researchers came from Europe to defend their findings. Ultimately, the panel rejected the report because the WHO wouldn’t provide the data it used to come to its conclusions.
It was set down to take two years and took four-and-a-half. Why?
Section 27 said: “The HMI has postponed the findings multiple times due to delays getting data from medical schemes and private hospitals, the complexity of the data and the analysis of it.”
In August 2017, the HMI announced it would publish the provisional report by November 30 2017. However, the three large hospital groups – Netcare Limited, Mediclinic SA and Life Healthcare – threatened legal challenges. The groups wanted to examine the data that were used to make the findings. Oellerman said all these concerns have now been dealt with.
Could you be in for a surprise?
South Africans regularly assume that private healthcare is unreasonably expensive, with the panel tasked to find out why. However, a shock could come in that hospital groups have asked the panel to see if this is actually the case – essentially to determine if there really is a problem, rather than merely an assumption that there is.
SA Society of Anaesthesiologists chief executive officer Natalie Zimmerman said private healthcare was 10 times cheaper for South Africans than for American consumers.
What recommendations are expected?
The Competition Commission in 2004 banned collective bargaining between doctors, hospitals and medical aids as it was seen as price-fixing.
This ruling formed a main part of the inquiry, with many saying the end of bargaining led to a spike in prices. Zimmerman said it is widely expected that the panel will suggest that hospital groups, doctors and medical aids be permitted to bargain and come to a fair price for a procedure, which would help consumers and give guidance on fees to doctors.