Many ways to medicate SA’s sickly health care system
It's hard to compare medical aid schemes and know whether your hospital is good or bad, but it doesn't have to be like that, say healthcare professionals
Consumers are getting a raw deal when using the private healthcare system, but most of what has to be fixed is up to government to do, said two of the panelists involved in the inquiry into the cost of healthcare.
The Health Market Inquiry panel, set up by the Competition Commission, spent four years investigating whether lack of competition was making medical aid schemes and private hospitals too expensive for consumers.
This week, two of the five panellists – Professor Sharon Fonn, head of the Wits School of Public Health, and Dr Nthuthuko Bhengu, a Harvard alumni – spoke publicly for the first time about the report at Wits.
They noted that most of their suggestions for improving private sector prices, transparency and competition were within the ambit of the government.
Fonn said: “Implementation will be in the hands of government to steward or lead.”
But healthcare consultant Dr Johan Serfontein was sceptical that this would happen. He said there was no incentive “for government to fix private healthcare and drive down prices because then they wouldn’t have as much of a need for national health insurance”.The inquiry report criticised the government's track record as showing “inadequate stewardship” of the private sector, with incomplete laws .
But Fonn said only consumers thought something was wrong with the system. “Everyone else [hospitals, medical aids] think things are going fine.”
Fonn explained that panellists were tasked with investigating whether there was proper competition in the private healthcare market.
Competition pushes prices down as companies compete for business. But the private industry was not competitive, said Fonn.
Three hospital groups – Netcare, Life Healthcare and Mediclinic Southern Africa – account for 91% of hospital beds and each group dominates a different province.
Bhengu said the panel recommended a government body, a “supply-side regulator”, which would decide if a new hospital was necessary and also might stop granting hospital licences to the three dominant firms. This may allow day hospitals or other hospital groups to compete.The investigation concluded that building too many hospitals led to unnecessary hospital admissions.
"We have 10 times the rate of intensive care unit (ICU) admissions as Switzerland per 100,000 people," said Wits School of Governance Professor Alex van den Heever.
The proposed government regulator would reduce ICU beds, which would reduce unnecessary ICU stays for patients who were well enough to be treated in general wards.
“We must do something really terrible in hospital that most patients land up in ICU,” joked Fonn.
The government would need to set up this regulatory body.
Serfontein said the reason doctors put patients into intensive care was because nursing was better there than in general wards, so he didn’t think limiting ICU beds would help solve the problem.The panel found that medical aid schemes were too complicated to allow comparison and described consumers as "disempowered and uninformed".
It proposed a basic set of benefits that every medical scheme would have to offer, something that would require government legislation.
Fonn said: “The important thing here is that if you can compare between one scheme and another you can make a real choice.”
It is normal abroad and seen as better medical practice for doctors and therapist to work in teams in some cases. The teams charge a single fee, which can be cheaper.
Teamwork and billing together is banned in SA. For example, a breast cancer patient could be seen by a team that includes the surgeon who removes the tumour, an oncologist who administers chemotherapy, a psychologist, a nurse, a plastic surgeon and a physiotherapist to help with movement after operations.
Bhengu said doctors were stuck with the “straitjacket rules from 1970s”, stopping multidisciplinary teamwork.It is up to the regulator, the state-run Health Professions Council of SA, to change the rules that currently prevent doctors working in teams.
Fonn said that in healthcare consumers had no knowledge of what they were buying. She compared it to buying a bed, where the consumer had information about the product, could try it out, and could compare price and quality.
But when it came to their health, patients did not know which hospitals were good or awful, or whether all the tests the doctor ordered were necessary. They also did not know their doctors’ track records.
Fonn said one could not buy private healthcare “intelligently”.The panellists proposed a government body that would measure and publicise doctor and hospital quality – including if patients felt their operations had helped them.
Fonn said: “We initially hope that interested parties will take this forward immediately as a voluntary activity but it is important that required legislation be made ready and passed immediately so that making this mandatory can be operational in a few years.”
Serfontein was sceptical about the government’s role and said if it wanted to fix the private sector it could already do so since most of the necessary laws were in place.
“For example, there is already legislation allowing the health minister to publish the maximum tariffs that doctors can charge. There is nothing to prevent him doing it, but he doesn't.”