Category Archives: Medical Aid

Information on Medical Aid schemes in South Africa

Pandemic brings out interesting hospital admission trends

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There has been a proliferation of models which predict hospital admission rates when the Covid-19 infection rate accelerates, but there have been very little focus on what is happening in our hospitals right now.

The interventions aimed at mitigating the impact of Covid-19 have already had a dramatic effect on hospital admission rates. These effects can change the way medical schemes approach the management of hospital admissions after the pandemic, the way that medical schemes plan to fund the cost of the pandemic and the way that medical schemes manage affordability constraints.

Many hospitals have temporary suspended elective admissions in order to minimise the risk of spreading Covid-19 and build spare capacity for virus patients. Patients too are wary of being hospitalised unless deemed absolutely necessary.

Dramatic reduction in admissions

We have seen a dramatic reduction in hospital admission rates, in the order of 50% across admission types, across medical schemes.

The admission rate for surgical cases has declined by more than 60%. Many types of surgery and theatre-based investigation are elective and can be delayed. For example, cataract procedures and diagnostic scopes are amongst the most common surgical procedures and both can often be deferred.

The admission rate for medical cases has declined by more than 40%. This is more surprising as medical admissions are not typically elective and admissions cannot usually be delayed. For example, one does not choose to develop a pneumonia or gastroenteritis that is severe enough to necessitate an admission.

This suggests either that there is some surplus demand for medical admissions that could be mitigated with proper intervention or that necessary care is currently being forgone.

In the case of the former, care systems could be better designed to minimise superfluous admissions. This would require the reorganisation of healthcare providers into patient-centred teams with aligned reimbursement models. Certain managed care techniques would also need to be reconsidered.

If care is being forgone due to Covid-19 and the lockdown, we could expect health outcomes to deteriorate. Mortality rates and other adverse outcomes may rise. There is a risk that patients delay seeking care for too long and only engage the health system when their conditions are more severe.

The more than 50% decline in the hospital admission rate will save medical schemes more than R1bn a week for so long as the trend is sustained. Over the five-week lockdown period savings will exceed R5bn.

Utilising the surplus

This raises the question as to how these funds should be utilised in these extraordinary times. The more conservative among us might suggest that funds should be used to build reserves in preparation for the full force of Covid-19 or to facilitate temporary financial relief for members.

A less obvious but more proactive approach would be to directly capacitate the public and private healthcare sectors in the interest of members.

Conservatively, R5bn could fund the production of more than 20,000 ventilators, which could cater to the needs of more than 400,000 infected patients. and countless pieces of personal protection equipment.

Perhaps, all these approaches should be pursed but to varying degrees. Funds should be directed towards the building of reserves, facilitating temporary financial relief for members and the procurement of vital healthcare equipment. In this way, schemes can play their part in combatting Covd-19.

CMS ruling: Patients could demand medical aids pay for treatments

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A ruling by the Council for Medical Schemes (CMS) opens up the potential for members to demand that their medical aid pays for any drug or medical care deemed necessary by a doctor to treat any disease that falls under PMB basket of care.

This is after a glaucoma patient took on Discovery Health Medical Scheme because it refused to pay for a medicated device called a Xen stent to lower eye pressure as recommended by a specialist, even though it was willing to pay twice as much as the device costs for treatment it recognises. The medical scheme denied the claim on the basis that clinical evidence around the implant was weak. It also said it was legally entitled to refuse payment for the device because it was not available in state hospitals.

The ruling could have a huge impact for cancer patients, where, in the past medical aids have refused to pay for drugs outside of their formulary. Last year, Dr Sipho Bvuma asked his medical scheme Gems, to pay for a special drug treatment called Keytruda for his stage 4 brains cancer. At first, Gems refused because the medication is not registered in South Africa as a treatment option for the specific type of cancer. It was only after Bvuma instituted court proceedings that the scheme changed its mind.

Affordable healthcare in 2020

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Medical aid may feel like a grudge purchase until you find yourself faced with a health issue, and unexpected and expensive medical or hospital costs. Unfortunately, healthcare inflation continues to outpace general inflation by about 5%. So, while consumers continue to struggle to make ends meet, medical aids need to explore ways to contain costs without compromising the level of healthcare offered to members.

We cannot argue that high costs are beyond our control and expect our members to just take it on the chin. We need to continue to be proactive in finding new and innovative solutions to contain costs while still offering value and a high level of care. More active disciplined management will be required under the current economic climate in 2020.

We believe there are areas of inefficiencies. As stakeholders in the system, we need to address this constructively in order to change the healthcare landscape. This involves empowering both members and providers as was clearly set out in the recent Health Market Inquiry (HMI) Report. Some recommendations in the report, specifically the regulatory reform, will go a long way to transforming the current landscape and making healthcare more affordable.

Bonitas, like all medical schemes in South Africa, is a non-profit trust, registered with the Council for Medical Schemes (CMS). The schemes are owned by their members, governed by a board of trustees and all surpluses are invested back into the scheme on behalf of members.

Growth and retention of membership are imperative for any fund, so it is up to the scheme to find innovative ways of adding value and keeping costs as low as is sustainably possible. In addition, as the age of membership increases, schemes need to attract younger, healthier members to balance the risk pool. Bonitas has expanded its product offering to meet the needs of younger individuals – which has contributed towards its growth.

We feel confident we are addressing the issue of affordability and having a wider appeal thanks to our product lineup. Testimony to this is that we saw a growth of 50,300 members in 2019 (3.2%) despite uncertainty around NHI, a poor economy, low salary increases (around 5%) and an average rise of 10% in medical aid contributions.

Medical Aid – Making the right choice

Medical aid plans can be confusing which is why it’s important to compare the various options and benefits to ensure you find a medical aid that works for you and your family’s health and that is within your budget…

Bonitas 29 Oct 2019

Ways we manage costs

  • We create partnerships with defined networks of hospitals and specialist service providers who help us limit utilisation and costs, without compromising members’ access to quality healthcare.
  • Managed care: There is an increased prevalence of lifestyle diseases such as diabetes, hypertension and cardiovascular disease as well as HIV/Aids, cancer, chronic medicine management, back and neck pain, hip and knee replacements and mental illness. For this reason, we have a number of managed care programmes aimed at predicting and preventing conditions before they become chronic and managing them in the most clinically appropriate way.
  • Fraud, waste and abuse: The growing incidence of fraud, wasteful expenditure and abuse of member’s benefits is another factor that impacts the cost of medical aid. In partnership with our administrator, we have been meticulous in our zero-tolerance response to these unethical practices, deploying forensic software and other resources to identify and address these criminal activities. We involve our doctors and specialist networks in seeking solutions that service the interests of our members Over the past three years this has saved the scheme and its members over R174m. Significantly over R153m of this is attributable to a positive change in the claiming behaviour of wrongdoers after they were investigated and sanctioned.

1. How members can curtail costs

  • Use Designated Service Provider (DSPs) network for hospitals.

By using networks on certain plans we are able to get better rates for members without compromising quality of care. This, in turn, enables members to pay a lower monthly contribution in exchange for using DSPs.

  • Additional benefits

Check which benefits are included on your option that can potentially save significant day-to-day expenses. Such as preventative care benefits, ranging from basic screenings (blood pressure, cholesterol, blood sugar and body mass index measurements) through to mammograms, pap smears, prostate testing.

  • Minding the Gap

If your option applies co-payments for defined procedures or covers you for only 100% of the medical scheme’s rate (and not the rate actually charged by the doctor), it is worth your while to investigate gap cover. This is a separate insurance policy you can take out to cover you and your family, for the difference between the medical scheme rate and what the provider has charged you (up to a maximum defined level).2. Chronic and intermittent medicines

  • Almost all options on all medical schemes apply a medicine formulary. This is a list of drugs which the scheme will cover in full. If you use medication that is not on the formulary, you will be liable for the difference. Discuss the formulary medication with your doctor to see if this is appropriate for you.
  • The schemes can also specify that you obtain your medication from DSP pharmacies. If there are none close to you, most schemes also designate a courier pharmacy to deliver the medication to you at a preferred address.
  • Ask your pharmacists for generic medicine. 100 million prescriptions are filled for generic medicines in South Africa per annum. This equates to 78% of the generalised market opting for a far more cost-effective drug where the pharmacological effects are exactly the same as those of their brand-name counterparts

Everything implemented by Bonitas, designed to curtail spiralling health costs, is on behalf of our members. After all, the Fund belongs to the members, so any interventions are to protect their interests within the ambit of the Medical Schemes Act.

5 tips on choosing a medical aid

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Medical aid is one of the biggest cost centres on many family budgets, then there is the tricky business of understanding what is covered and what is not. It’s therefore important to choose one that is right for you and your health needs and will potentially not leave you financially ruined?

Tip 1: Find a medical aid you can trust

All official medical schemes should be registered with the Council for Medical Schemes (CMS). If you are worried that a certain provider is not legitimate, you can go to the CMS website to verify their validity.

No one knows your needs better than you. It’s up to you to do your own research. Luckily, schemes provide smart internet capabilities which can compare a wealth of information of their products in the market. Easy to access member feedback portals also provide first-hand accounts on how schemes treat their members.

You can also speak to a broker. With so many schemes out there, it can feel impossible to properly weigh up the pros and cons of them all. A reputable broker has knowledge of the different schemes and can provide a personalised answer based on your needs.

Tip 2: Know the difference between a medical scheme and health insurance

Confusion tends to set in when deliberating the difference between medical schemes and health insurance. In the end it comes down to cost versus benefits and remember cheap usually means fewer benefits.

If you need peace of mind or more generous care, then you definitely need a medical scheme. If you are looking for affordable basic cover under R500 a month, then you can look at health insurance. However health insurance products typically pay a larger proportion of your premium to marketing, distribution and administration costs.

When belonging to a scheme, remember you effectively are a shareholder of the business and with any remaining profit or “surplus” at the end of the year is then saved for future years claims. Medical schemes even the lowest cover sometimes refer to as “hospital plans” must offer what is known as Prescribed Minimum Benefits. According to CMS, these are benefits that ensure that all medical scheme members – regardless of the provider and the benefit option – must have access to certain minimum health services.

Prescribed Minimum Benefits are defined in the Medical Schemes Act, and all medical schemes have to cover the costs related to the diagnosis, treatment and care of:

  • Any emergency medical condition
  • A limited set of 270 medical conditions (defined in the Diagnosis Treatment Pairs);
  • 25 chronic conditions (defined in the Chronic Disease List)

Medical insurance sits on the other end of the value scale, paying a set amount for your stay in hospital. This cost is often not nearly enough considering the high costs of medical care in a general, high care or intensive care unit.

Tip 3: Understand the limits of a hospital plan

To cut costs, many people choose to downgrade their medical aid cover to a hospital plan. If you’re with a CMS accredited medical scheme, then you can rest assured that even the lowest level hospital plan should comply with the above mentioned Prescribed Minimum Benefits. You also need to be aware that every visit to the hospital emergency rooms does not count as hospitalisation. Even if you think it was a medical emergency, there is a difference between getting treated as an out-patient and being admitted and so some visits to emergency rooms may in fact come from your day-to-day or savings benefits unless you are admitted.

It is critical to understand that that many schemes have a limit on their hospital cover. They will require you to attend only certain hospitals and may have a hospital limit on what is covered depending on your scheme and plan.

Tip 4: When first becoming a member of a scheme, prepare to wait

If you are looking to sign up for medical aid, you can almost certainly expect a waiting period. There are two types of waiting periods or underwriting conditions.

The first is the general waiting period. If you are healthy, under 35 and haven’t been on a medical scheme before, you will generally only have to wait three months before full cover takes effect.

The second is called condition specific waiting period. This applies if you have a pre-existing condition or injury prior to joining the scheme. In these cases, the standard practice is that schemes apply a 12-month condition-specific waiting period before you can access benefits relating to these pre-existing conditions, which is standard practice.

It is best to disclose your pre-existing conditions as three or 12 months is not a long time to wait. This is a contractual relationship at the end of the day and by not disclosing your condition after signing the contract, the scheme has full rights to terminate you from the scheme and refuse cover.

An additional matter to be aware of is if you are delaying becoming a member of a medical scheme, you may be required to pay late joiner penalties for the rest of your life. This is applied by all schemes to encourage younger members to join early rather when its too late. These penalties will follow you regardless if you move medical schemes at a later stage and can cost you up to 50% more than the scheme premium. This is depending on your age.

Tip 5: Be careful of loyalty frills

It’s easy to get caught up in the excitement of loyalty benefits. The reality is that promoting healthy behaviour improves your lifestyle but things such as discounted flights or free movie tickets won’t help you when you have a car accident and are taken to the ICU. Too many people mistake frills and loyalty-based products as core healthcare benefits they are buying only to discover that they don’t have the proper cover they need when the time comes.

Don’t be fooled by big brands that market frills because you will literally pay the price when it is too late. Ultimately, it’s important to understand the pros and cons of choosing a medical aid especially based on your needs and affordability.

Heading towards value-based care

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Accessible and quality healthcare is a pillar of sustainable development and global security. The principle behind this is that no one should fall into poverty because they get sick and need healthcare. South Africa’s response to the global call for universal healthcare is the National Health Insurance (NHI) bill, which aims to provide everyone with access to appropriate, efficient and quality health services.

“The Health Market Inquiry has spelt out the failure of the private sector to make affordable quality healthcare available to more people. To move towards universal health coverage, holistic care delivered by a multidisciplinary team is required,” says Dr Brian Ruff, co-founder of PPO Serve.

Access to quality healthcare forms the basis for the realisation of a wide variety of socioeconomic rights. The purchaser role put forward by the NHI will ensure the efficient use of resources to benefit the country’s entire health system. “The model introduces a single fund that will also support the purchasing of medical services for the country,” he says.

In contrast to the current model, in which schemes attempt to manage care and spend through restricted benefits and pre-authorisation, the NHI fund will be responsible for the lives of 57-million South Africans. “Under it, providers – whether public, private, or not for profit – will compete for local contracts based on how well they deliver value. This includes primary healthcare and hospital services,” says Ruff.

Value-based care

The goal of universal health coverage is to provide full comprehensive care to all citizens and legal residents of a country. “By pooling funds, the NHI has the ability to provide access to quality and affordable health services for all South Africans based on their healthcare needs and irrespective of their socioeconomic status. There are many countries, with less resources who provide quality healthcare care for everybody,” he says.

To work effectively, the NHI needs to appoint a competent team to design template strategic contracts that are robust and fair. “These value-based care contracts must use payment models that support the use of all available resources, that reflect population needs and that reward good outcomes. This means the model needs case mix tools – data which shows that patients are treated at the right level of care relative to their illness – to be available at every level of the system.”

Population medicine models demonstrate their value by improved measures of both the quality of healthcare delivered, as well as a reduction in spend. “The strength of this team-based and community level model is in managing complex medical conditions as well as the direct impact of social, psychological and financial circumstances on patients’ illnesses and treatment,” says Ruff.

Sama makes NHI submission to Parliament

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While the South African Medical Association (Sama) is in support of the principles of universal health coverage and quality care for all, it has not been able to support the 2019 National Health Insurance (NHI) Bill in its current format, the organisation said in its submission to Parliament.

Sama raised many concerns and queries about unclear aspects in the 2018 draft Bill, and objected to many aspects proposed to be written into law. Examples include contracting and payment mechanisms which have never been implemented in the country before, as well as missing detail on quality of care expectations. There are also concerns about the amount of power which the Bill hands to the minister of health.

Sama ran a membership survey in November 2019 to gauge the feelings of its membership in relation to the Bill and the NHI proposals. It received 1,000 responses in the short two-week period in which the survey was open. Members do not think that a single fund is the only answer to securing universal health coverage for the population, and the membership is generally concerned about the lack of detail in contracting mechanisms, accreditation procedures and quality of care in general. The written responses indicate a deep mistrust of the government structures in general and the ability of the Department of Health to implement their plans in realising coverage for all.

Members agreed that the proposals for payment arrangements in the Bill are premature, and untested in the South African environment. Overall the Department of Health should pursue quality and finance improvement initiatives already proposed for the public and private sector before fundamentally changing the healthcare delivery system in the country.

Join the modern workplace with Microsoft Office 365 and Tarsus on Demand

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When you have a pain in the neck or back

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Back pain is a common problem – 80% of us will experience an episode at some point in our lives. It is associated with many factors that vary from person to person but can be caused by an injury, a disc or joint problem, an irritated nerve root or poor posture. The pain might be acute or chronic but living with either can be debilitating.

Pain is considered chronic if it lasts more than three months and exceeds the body’s natural healing process. Either way, failing to get pain relief after different treatments is very frustrating. It can lead to depression, loss of working hours, extensive treatments and often sufferers lose hope and resort to popping painkillers or going for surgery. Both of which can be counterproductive.

Surgery not the only option

Many people assume that surgery is their only option to treat severe back pain. However, according to Dr Jacques Gilau, clinical head for Dr JJ Gilau and Partners utilising Documentation Based Care (DBC) technology in South Africa, ‘only a small percentage of people with back pain require surgery.’ DBC uses effective methods of musculoskeletal rehabilitation and physiotherapy for back and neck pain. Usually a 6-week interdisciplinary programme that includes treatment by doctors, physiotherapists and biokineticists. 

Bonitas Medical Fund has partnered with DBC so that its members have access to a back and neck programme of up to six weeks, to either prevent surgery or, when it is unavoidable, prepare and strengthen ahead of surgery and rehabilitate afterwards. 

Lee Callakoppen, Principal Officer of Bonitas says, ‘We believe in the preventative management of chronic back and neck pain and since partnering with DBC have received excellent feedback. Members are staying active, developing a better understanding about their pain, identifying the factors involved in their pain and living regular lives. For this reason we cover the full DBC treatment programme.’

According to the DBC statistics, the success rate for treating chronic back and neck pain to avoid surgery is 91% at two years follow-up. DBC has 18 equipped centres in South Africa and the treatment programme is for up to 6 weeks, after which time there are check-ups to ensure that the home programme is effective. 

Back, neck and shoulder problems affect many people and are often the result of stress and lifestyle specific issues. Those receiving treatment at the DBC centres range from between the ages of 11 and 93.

Bonitas does not wait for members to contact the scheme when they need help, as part of the Managed Care programme, they use predictive modelling capabilities to support members who may benefit from this service by proactively contacting them and encouraging them to join the DBC programme. 

One patient who was contacted by Bonitas when she was suffering from chronic back pain tells her story. 

Bonitas back and neck programme give woman her life back

Thandiwe* has Lupus, a systemic autoimmune disease that occurs when your body’s immune system attacks your own tissues and organs. Inflammation caused by Lupus can affect many different body systems — including your joints. She has already been through two hip replacements, surgery to both shoulders, her right knee and her ankle. In 2018 when she started developing lower back pain that went down into her thighs and knees, she knew the disease had started to affect her back. She had to use either a walker or a wheelchair. 

She says, ‘I couldn’t walk because of the sharp burning pain. I went to see an orthopaedic surgeon and a neurologist and they confirmed that Lupus was affecting my spine.’ Thandiwe was not a candidate for surgery and was at her wits’ end. Besides not being able to walk she couldn’t do house chores, go the mall or visit family or friends. ‘The worst was when the pain sort of locked my knees, even making standing painful.’ 

Bonitas, with whom she has been a member for 28 years, phoned her during this time and told her about the DBC back and neck programme. 

The doctor at DBC said that her lower lumber vertebra, L4 and L5 are degenerating and that the multi-disciplinary programme of healthcare practitioners would help her. 

The six week programme started immediately and she said that apart from consulting with the doctor she saw various therapists and had a range of treatments, including, deep tissue massage, dry needling and thermal therapy. DBC creates a customised set of therapies according to the patient’s particular needs. ‘Initially using the exercise equipment was very difficult but I felt more comfortable once the doctor checked my progress and gave advice.’ 

She says after a month, she started to walk slowly without a walker and didn’t need her wheelchair. ‘I felt much better and the doctor was pleased with my progress but recommended that I continue with the programme. 

‘The best part of the programme is the fact that the pain is reduced, at last I can sleep on both sides and turn in my bed and I can also use the exercise equipment without feeling so much pain. I just feel so much better. I can walk around the house without any assistance. I still keep up the exercises I was given.” 

Thandiwe is on the Standard option with Bonitas and the entire cost of the DBC programme was covered. 

‘Continuous pain makes you feel depressed and you feel as if you have no life. I am feeling so confident and my self-esteem has started to return. I have my life back! 

‘I still have a long way to go but it is the best thing I have ever done. I am continuing with my exercises and looking forward to even more improvement.’

*The name has been changed for privacy purposes

How a lack of competition in South Africa’s private health sector hurts consumers

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The investigation ran over five years and included over 43 million individual patient records, 11 million admissions, specifically commissioned studies, written submissions, public hearings and seminars. The investigation focused on hospitals, doctors, and funders. Funders include the medical schemes who purchase healthcare on behalf of members, and the administrators and managed care organisations that medical schemes contract with.

South Africa’s Competition Commission set up the inquiry in response to prices in the private healthcare sector which, it said, only a minority of South Africans could afford. The country has a two-tiered health system. About 71% of the population uses public sector, while the private sector serves around 27%.

Ideally competition should translate into lower costs and prices, better quality, and generally more value for money for consumers. In its final report, which was released recently, the inquiry found that competition wasn’t working as it should in private healthcare. The sector was characterised by high and rising costs, significant overuse, and no discernible improvements in health outcome.

Lack of competition

There were a number of factors that – alone or in combination – led to a lack of competition in the sector.

One factor is that three hospital groups dominated the facilities market: Netcare, Mediclinic and Life. They accounted for more than 80% of the hospital beds and 90% of all the admissions. These three hospital groups, both individually and collectively, were able to secure steady and significant profits year-on-year. A few firms owning the majority of the market is an indication that competition may not be working effectively.

Hospitals don’t attract patients, they compete for doctors who admit patients. Most doctors had contracts with the big three. Successful entry by new hospital owners is very difficult as they cannot attract doctors as easily.

Hospital groups are also able to build additional hospitals where they aren’t needed, resulting in an oversupply of beds and ultimately overuse of services.

In South Africa more people are admitted to ICU compared to eight other countries with comparable published data. The inquiry panel estimated that the country could save more than R2.7 billion – or 2% of its current private health care spend – if it halved the number of people admitted to ICUs and improved the care for patients in wards. Only the critically ill should be admitted to ICU. But the inquiry found that some of the patients who were in ICU could have been treated in wards.

There are no measures of quality of care in the public domain. This means that members of medical schemes and funders (who purchase healthcare on behalf of medical scheme members) weren’t able to judge if the care provided by doctors and specialists was effective.

The entire premise of effective competition is that purchasing healthcare services should be based on value – a combination of price and quality. This isn’t possible in South Africa.

There’s no way to assess if the care provided was improving health outcome. This is particularly problematic as the inquiry found significant over-servicing by doctors which cannot be explained by their patients’ level of illness. Doctors use a fee-for-service billing model. This means they bill patients for each service they perform during a consultation. In this system, the more you do the more you earn. This is called a perverse incentive and without knowing the impact of health outcomes neither doctors nor patients know if the extra tests or interventions are worth the cost. They also don’t know if it is improving health outcomes.

The inquiry also found doctors and specialists worked as individuals -– not as a team. There is growing evidence and acceptance internationally that team-based care is better and more cost effective.

Medical schemes compete for younger and healthier individuals. To do this, schemes have created numerous benefit packages. But these packages aren’t comparable. Medical schemes have done this in response to the absence of a mechanism for equalising risk between medical schemes. Medical scheme members do not know what they are paying for. Neither are they able to judge the quality of care.

Recommendations

The recommendations are aimed at creating greater competition, transparency, and accountability on how medical scheme member’s money is spent. They also aim to increase competition on the supply side (hospitals, doctors, and specialists) and on the demand side where funders represent the consumer.

Recommendations include a supply side regulator, whose job will be to:

  • assist provinces in issuing licenses for hospitals;
  • assist with a process and a platform for price setting for doctors;
  • conduct or contract out research looking at cost-effective healthcare interventions, including technology; and
  • facilitate access to reliable information on quality of health and health outcomes measurement.

To increase competition on the funder’s side, and to improve transparency for the consumer, the recommendations include that all medical schemes offer one comparable insurance package. In addition, government should introduce a mechanism to equalise risk between medical schemes so that they compete on the merits – not on risk or age selection.

What next

The recommendations have implications for the South African governments plan to introduce a National Health Insurance in a bid to level out the playing field between the public and private health care sectors. The plan is that the National Health Insurance will operate as a funding mechanism to move South Africa closer to universal health coverage.

Implementing the recommendations set out in the inquiry report is an essential step towards creating an environment where the purchaser – the National Health Insurance fund – will purchase from a private healthcare market that is competitive with lower costs and prices, and more value for money for consumers.

The National Health Insurance bill talks about strategic purchasing or value based purchasing which refers to using the capacity in the private sector to relieve the public sector. This aligns with the health market inquiry recommendations.

But it needs an independent supply side regulator to enable competitive price setting and coding mechanisms. Codes form the basis on which prices are determined – which is necessary for the National Health Insurance fund to reimburse providers. Value based purchasing also requires implementation of performance and outcomes reporting and monitoring.

This article is republished from The Conversation under a Creative Commons license. Read the original article.The Conversation