SECTION27’s submission to the Health Market Inquiry

In its submission to the Health Market Inquiry into the private healthcare sector, SECTION27 discusses the importance of an evidence-based analysis of the merits of price regulation within in the health care sector.

We note that the current absence of an effective framework for price regulation has the effect of compromising patient’s rights to high quality, affordable health care services, despite the positive duties on the state to progressively increase access to health care services.

We identify the harmful effects of the failure of the Professional Boards to fulfil their obligation to publish fee norms, noting that this regulatory gap effects patients’ ability to exercise their right to complain about overcharging by health professionals.

And, we investigate the extent to which the Council for Medical Schemes (CMS) has been effective in implementing existing regulations on Prescribed Minimum Benefits (PMBs) and preventing what appears to be widespread non-compliance with the coverage that all medical scheme members are entitled to by law, without any co-payments. As our patient testimonials, annexed to this submission, strongly indicate there are serious physical, emotional, psychological and financial harms caused by this non-compliance.

Our submission therefore grounds itself on an understanding of the centrality of the constitutional right to access to health care services to the Health Inquiry Panel’s investigation into the private health care sector.

SUMMARY OF RECOMMENDATIONS

SECTION27 makes the following recommendations:

Price regulation

Based on international experience and the submissions on the 2010 proposed process to regulate prices, SECTION27 makes the following recommendations:

  1. A thorough, evidence-based, investigation by the Panel into potential price regulation in the private health care sector;
  2. An approach to price regulation as a means of fulfilling the state’s duty to protect the rights of users of the private health care sector;
  3. Any recommended process for price setting should be transparent and independent and should include meaningful participation by relevant stakeholders;
  4. The determination and definition of the roles of existing statutory bodies (in particular the CMS, HPCSA and the Competition Commission) in the process of price regulation to prevent interventions which disrupt effective price regulation.

Council for Medical Schemes

SECTION27 encourages the Panel to make recommendations to assist and equip the CMS to fulfil the crucial function of ensuring compliance with PMBs. In particular, an assessment of the CMS’s existing capacity to fulfil this function, including: access to human and financial resources; medical scheme members knowledge of and accessibility to its complaints procedures and mechanisms; ability to enforce compliance with their decisions; and political independence.

Health Professions Council

SECTION27 urges the HPCSA to urgently complete the ethical tariff process started in 2012. This is an important step in achieving greater equality in accessing health care services for health care users in the private health care sector in accordance with the Bill of Rights. General recommendations 11.

The Panel’s recommendations should aim to achieve more equitable access to health care services. The panel must consider whether any proposed intervention will have the effect of diminishing access to health care services, and, if it does, reject such a proposal.

SECTION27 recommends that the Panel and the Commission complete all-important investigation into the private health care sector as expediently as possible. The process of initiating the Health Inquiry and implementing its beginning phases have already been subject to unnecessary delays as a result of litigation initiated by a significant stakeholder in the inquiry.

Though it essential that the entire inquiry process complies with proper, fair process within the bounds of the law, SECTION27 notes that further delays in the inquiry process would allow existing rights violations to continue. As our patient testimonials indicate, these violations result in significant, avoidable human suffering.

For this reason, and to avoid the complications and delays involved in the implementation of the recommendations made by the Panel in terms of the banking inquiry, SECTION27 recommends that the Panel should propose a process to be followed in the assessment and implementation of its recommendations.

For more information contact:

Umunyana Rugege:        rugege@section27.org.za

Tim Fish Hodgson:          fish@section27.org.za