The Competition Commission’s long-awaited Health Market Inquiry (HMI) has found that the private healthcare sector is “highly concentrated”, “characterised by high and rising costs of healthcare and medical scheme cover, and significant over-utilisation without stakeholders being able to demonstrate associated improvements in health outcomes”.
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The panel found there are three hospital groups dominating the market – Netcare, Mediclinic and Life Healthcare, which has potential to “distort and prevent” competition. More competition, it said, would translate to lower cost and prices and more “value for money” for consumers.
However, Mediclinic has challenged this assertion, saying it (and the other two groups) had submitted data analyses and research studies indicating that the conclusions are “incorrect and outdated”.
“It is important to note that the market context has moved on since 2014; the end date for the majority of data used. Current data must be used to find current best solutions for the unique South African healthcare market, especially as South Africa prepares itself for the introduction of the NHI,” said Koert Pretorius, CEO of Mediclinic Southern Africa.
The report recommends that a number of oversight bodies be set up to rectify regulatory failings related to private healthcare.
Supply Side Regulator for Healthcare (SSRH)
The National Health Act of 2003 makes provision for appropriate geographical distribution of facilities based on population need. However, when the National Department of Health’s tried to implement this measure, 11 years later, it failed because it didn’t have the necessary regulatory framework necessary for implementation.
The report therefore recommends that the SSRH be set up to regulate health facilities and practitioners. Its duties will include capacity building and issuing facility licences that follow national guidelines developed by a technical team.
It will also set up a negotiating forum for practitioners to set a maximum price for prescribed minimum benefits or PMBs. Additionally, practitioners will also set reference prices for non-PMBs.
Outcomes Monitoring and Reporting Organisation (OMRO)
This body will be set up as a platform for providers, patients and all other healthcare stakeholders to provide “patient-centred” and “scientifically robust” information on healthcare outcomes.
As hospitals, doctors and patients cooperate in generating information on healthcare outcomes, it will provide practitioners and hospitals with relevant information and ways to improve clinical quality.
It will also help provide patients and funders with relevant information on health outcomes for decision-making purposes.
Health Professions Council of South Africa (HPCSA)
Changes in the ethical rules of the HPCSA would promote innovation in models of care, the report said.
This includes mandatory ethical training at both undergraduate and postgraduate level so future healthcare professionals are aware of cost implications of their decisions.
“The existing HPCSA ethical rules prohibit joint initiatives to develop new efficient and cost-effective care delivery models,” Mediclinic said.
Medical schemes
“The principal officers and trustees of schemes could be more active in ensuring that beneficiary interests are protected… there is a need to strengthen the role played by the boards of trustees and principal officers to ensure the member is always put first,” the report read.
In addition, it proposes a single, comprehensive standardised base benefit option will be introduced and offered by all schemes.
This is “to increase comparability between schemes and to increase competition in the funders market,” the report read. This will enable consumers to compare products, reward funders able to innovate and offer lower prices or at a higher quality.
Mediclinic supports bilateral tariff negotiations between facilities and funders. “Quality outcomes information has been an ongoing issue as flagged by Mediclinic’s participative submissions in the HMI process… This will provide patients, healthcare professionals and funders with greater transparency on clinical performance information,” the group said.
