09 July 2018

10 major points revealed by the Competition Commission's private healthcare probe

The Competition Commission has spilled the beans on their inquiry into the private healthcare sector, and the provisional report makes some shocking revelations.

Following the release of the Competition Commission's provisional Health Market Inquiry into the South African private healthcare sector, many concerning issues have been raised.

Of the several investigations into many facets making up the sector, pricing and value-for-money services were major bones of contention.

The inquiry, which has taken the commission four years to put together, has revealed that one of the major reasons for looking into private healthcare has been to figure out the reasons behind price increases and the increase in expenditure.

During their investigation, several comparisons were made with other countries' healthcare sectors, more specifically those belonging to an international institution – the Organisation for Economic Co-operation and Development (OECD).

In his presentation, former Chief Justice Sandile Ngcobo made mention of four broad areas of key findings – and from these key findings, we've extracted nine major points:

1. The cost of private healthcare is high

Based on the way medicine has advanced, higher medical bills are reasonable, but the inquiry found that while some expenditure can be explained, there is also a portion which cannot be explained, and in certain instances may be unnecessary. Practitioners and hospitals may also be overinvesting in technology and administering unnecessarily expensive treatments.

2. Patients receive unnecessary treatment

There is great concern about patients being prescribed treatment they do not really need. In his presentation, Ngcobo said that under perfect conditions doctors would only prescribe treatment that is absolutely medically necessary.

There seems to be many instances where practitioners encourage patients to consume more than is needed — for example, if a doctor orders more tests than necessary, or conducts a Caesarean section (C-section) when it's not necessary.

3. Increasing cost of medical scheme premiums

The prices of medical scheme premiums continue to increase, and still members are expected to supplement the cost of certain procedures or medications out of their own pockets.

4. Confusing medical scheme products

Most medical schemes have a broad portfolio of products, which can make it difficult for consumers to come to an educated, informed conclusion about their purchase. Often consumers aren't able to run a comprehensive comparison between various products, which makes the selection process even more difficult.

5. High usage

The rate at which patients are using healthcare services is high, according to the inquiry. After running the numbers against those of several other countries in the OECD, the panel discovered that the utilisation rates in South Africa are much higher. Again, this may be due to overprescription or treatments that are completely unnecessary.

6. Implementation of regulations, or lack thereof

The inquiry highlighted that there is a great deal of regulatory constraint across the private healthcare sector, but this could be easily mitigated if the National Department of Health enforced the laws promulgated in the National Health Act.

7. Little to no competition between medical schemes

When the panel looked into competition among medical schemes, Discovery Health was pegged as the market leader. The inquiry states that other schemes simply follow Discovery's lead. This practice does not allow for healthy competition or for the improvement of product development, which negatively affects affordability and value for money.

8. No competition among specialists

The inquiry highlighted the apparent lack of competition among specialists in the sector. Most practitioners go into private practice on their own and don't form practices with a multidisciplinary approach, which would translate into better value for money for consumers.

Practitioners are also rarely required to report on the outcomes of their patients or on the quality of service they provided. This makes it difficult to measure their services against a benchmark or best practices.

9. Hospital competition

There are only three major hospital groups in South Africa and these groups dominate the private healthcare sector. The inquiry discovered that there isn't necessarily direct competition between the groups, but that there are incentives between specific practitioners and hospitals for patient referrals, in order to maintain or increase hospital admission.

10. Private vs. public healthcare

The inquiry was specifically into the private healthcare sector, but even though there has not been an investigation into public healthcare sector by the Competition Commission, the Executive Summary for the provisional report states that even though there is a belief that private healthcare is better than public healthcare, it is quite challenging to come to a solid conclusion on this matter.

Reasoning behind this is not because the commission hasn't done a study into the public healthcare sector, but because there is "no standardised means of measuring and comparing quality of healthcare services or outcomes". The summary adds that there is no measure of cost-effectiveness in the private healthcare sector.

The Competition Commission's provisional report on the Health Market Inquiry is open for comment until 7 September. All substantiated comments which are submitted to the commission before the closing date will be taken into consideration before the final report is published at the end of November.