Patient voices to finally be heard in the Health Market Inquiry
In the early hours of 4 May 2011, Phindile Mlotshwa was startled awake because she couldn’t breathe. She didn’t make it to work that day because she had difficulty drawing breath and very quickly developed a severe headache. She consulted a doctor for what she thought were flu symptoms. He sent her home with medication.
On 6 May 2011, she was then admitted to the Life Brenthurst Clinic for respiratory problems. Phindile belongs to one of the largest medical aid schemes in South Africa so she was confident that all her bills would be paid. Her medical aid confirmed authorisation for her hospitalisation and a CT sinus scan but did not pay for the scan instead expecting a part payment for the procedure. The CT scan detected that Phindile required an operation to drain pus from her sinuses.
Additionally, her medical aid refused to pay for the operation stating that the procedure was not covered by her benefit plan. Phindile relied on the medical aid’s member guide when she made her claim and expected that the procedure would be fully covered. There exists an information gap between what the medical aid published in its member guide and the practices of the scheme. Phindile’s story illustrates one of the key points of SECTION27’s submission to the Market Inquiry into the Private Healthcare Sector. Public hearings will begin on Tuesday, 16 February 2016.
In December 2015, The Competition Commission issued notices alerting members of the public to come forward and give testimony about their experiences with private health care stakeholders, ranging from hospitals to medical schemes.
The inquiry’s terms of reference describe private healthcare costs as being “at levels only a minority of South Africans can afford”.
Various explanations for the “cost, price and expenditure increases in the private healthcare sector” will be examined in the context of the right to access healthcare services as enshrined in the Constitution. In addition, an assessment of gaps in existing regulations forms part of this investigation.
SECTION27, together with a number of patient groups and organisations working in the health sector will make submissions to a panel led by Judge Sandile Ngcobo.
SECTION27 intends to focus on:
- the need for price regulation of health services;
- the need for greater compliance with the social protections contained in the Medical Schemes Act by all players in the industry, but particularly the medical schemes; and
- the implications of recent developments, including the investigation into the ineffectiveness of the Health Processions Council of South Africa initiated by the Minister of Health.
The organisations, including the Rural Health Advocacy Programme, the Southern African HIV Clinicians Society, South African Federation for Mental Health and the South African Depression and Anxiety Group, will discuss issues such as:
- Dumping of patients into the public sector;
- Human resources imbalances in the sector;
- Patient referrals between the private and public sectors; and
- Coverage for mental health conditions.
The first set of hearings is scheduled to take place from 16 February to 10 March 2016 followed by further consultations.
As part of the inquiry, the Commission may recommend new or amended legislation, regulations and/or policies and may also make recommendations to regulatory authorities such as the Council for Medical Schemes or the Health Professions Council of South Africa.
The constitutional obligations of state entities, the existing regulatory bodies and the participants in the private healthcare sector themselves must be central to the recommendations made by the Inquiry.
The Competition Commission is scheduled to table its recommendations by December 2016.
Follow SECTION27 on Twitter for updates from the public hearings. #healthinquiry #hmi #health4all
For more information please contact:
Umunyana Rugege 011 356 4120 or 083 458 5677 or Rugege@section27.org.za
Ntsiki Mpulo 011 356 4123 or 082 782 7143 or Mpulo@section27.org.za