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FINANCIAL MAIL Consumers are not clear on the quality of care they receive, and high costs do not always mean greater value to them The complexities of the private health-care sector, including the rising cost of health care, is under investigation by the Competition Commission through a Health Market Inquiry (HMI), which commenced five years ago. Chaired by former chief justice Sandile Ngcobo, the inquiry has conducted extensive investigations into the intricacies of the private health-care environment. It released its provisional report in 2018, making a number of recommendations on both policy and regulation in order to support accessible, affordable and quality private health care. The report found that transparency, competition and concentrated ownership are all issues in private health care. Consumers are not clear on the value they are getting or what the measures of quality are. The report identified the key drivers leading to rising health-care costs, finding that while costs are growing, consumers are not necessarily receiving greater value, and that more competition is required. Private hospitals are not making high levels of profit, though some medical scheme administrators are making significantly more profits than their competitors. The report also flags the fee for service billing method prevalent in private health care in SA. Internationally, team-based care is becoming an accepted standard, providing better care and lower costs. In SA, however, doctors and specialists use a fee-for-service profit billing method which, according to the HMI preliminary report, stimulates oversupply, wasteful expenditure and encourages practitioners to provide more services than necessary. In SA, this issue is made worse by the unregulated pricing environment. The report adds that where new models of care have been attempted, funders have been slow to embrace them. Discovery Health CEO Jonathan Broomberg says the Health Professionals Council of SA's rules stand in the way of implementing team-based care and integrating care across providers as they prevent health professionals from being employed by a hospital or other entity, which in turn prevents health professionals operating and billing together in teams. The regulations, he says, need to allow doctors to work in multidisciplinary teams and to contract with medical schemes on a basis that aligns the incentives to deliver treatment in a way that promotes the best outcome for patients. This will improve affordability and promote a treatment framework that is more aligned with a holistic high-quality outcome, and a remuneration structure for doctors that rewards good health outcomes.
Created at 2019/03/25 02:38 PM by Mediclinic
Last modified at 2019/03/25 02:38 PM by Mediclinic