Johannesburg, 30 September 2019 - SECTION27 and the Treatment Action Campaign welcome the publishing of the final report of the Competition Commission’s Health Market Inquiry (HMI). This has been an…
The findings and recommendations of the HMI are critical to the public debate on the National Health Insurance and the Medical Schemes Bills, and thus it is critical that these findings are made public as a matter of urgency.
The study was roundly criticised by the South African hospital groups and funders such as Discovery Health, particularly on the grounds of what were described as technical and methodological flaws. Discovery, Mediclinic and Netcare made further written submissions to the HMI, criticising the study and its conclusions.
Bonitas explained that there has been an increase of approximately 52% in the cost per year, per beneficiary in terms of PMB claims. It added that the proportion of PMB claims in hospitals had increased more rapidly than for services provided outside of hospitals.
The explanation Bonitas proffered for this was “upcoding” by healthcare professionals, because schemes must pay on invoice in full and that “the PMBs have made South Africans Hospicentric”. The result is that “most of our members actually end up in hospital”, which Bonitas’s representative plainly admitted “is a problem”.
Demand, the FDoH submitted is related to want which can be created whereas need is related to, amongst other things, burden of disease and availability of healthcare services. Demand for private healthcare is higher in Bloemfontein than anywhere else, with result that there is excess capacity in terms of beds. This happens at the same time as the need is high in poorer more rural areas, but the demand is lower because people are less able pay for private healthcare.
Brain Ruff, the founder of PPO Serve Integrated Clinical Consortia, a consultancy of healthcare professionals, presented to the Health Market Inquiry on 17 May 2016. He indicated that he had…