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Mediclinic News : More control needed to ensure medical scheme members get better value

Title

More control needed to ensure medical scheme members get better value

Date

2016-05-17

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News Description

BUSINESS DAY The Department of Health should exert greater regulatory control over the private healthcare sector to ensure patients get value for money, former Discovery Health executive Dr Brian Ruff told the Health Market Inquiry earlier on Tuesday. The inquiry was established by the Competition Commission to determine why medical inflation consistently outstripped consumer price inflation and to assess whether there were barriers to competition and patient access. It is currently holding public hearings in Durban, which it is broadcasting online. "There is a crisis of access and affordability. The current narrative ignores the poor performance of the healthcare system — it produces unnecessarily high costs and therefore high (medical scheme) premiums," said Ruff, who is now the CEO of the start-up healthcare management company PPO Serve. Excess capacity and fragmentation of care led to over-servicing and supplier-induced demand, which pushed up costs, he said. "There is a lot of evidence that there is excess capacity in some areas of the country. We are approaching four private hospital beds per 1,000 medical scheme members and in some areas it is as high as six beds per 1,000," which pushed up costs, he said. A more appropriate figure would be 1.5 beds per 1,000 medical scheme members, he argued. Negotiations between medical schemes and healthcare providers such as hospitals were entirely focused on price, with no consideration given to the clinical outcomes achieved. At the same time, medical schemes competed for patients on the basis of the benefits they offered and their premiums, rather than their capacity to negotiate value from providers, he said. Private hospitals and clinicians should be required by the government to measure and publish data on the quality of the care they provided, said Ruff. They could then compete for medical scheme members. The state should also play a much more aggressive role in how it licensed private hospital beds, determining the number required for the needs of specific regional populations and revoking licences if hospitals failed repeatedly, he said. Ruff said the Medical Schemes Act should be amended to allow regional medical schemes, as the requirement that they offer national coverage blocked new market entrants and hampered competition. Doctors should be encouraged to work in teams rather than in isolated practices, as this would improve the quality of care for patients.
Created at 2016/05/23 05:46 PM by Mediclinic
Last modified at 2016/05/23 05:46 PM by Mediclinic