Health inquiry backs standard medical aid options and tariffs

Standard tariffs for medical practitioners and the standardisation of medical scheme options are in the offing if the government decides to implement the Competition Commission’s recommendations, following an inquiry into the private healthcare market.

The provisional report of the inquiry, which was released at a briefing on Thursday by commission chairman and former chief justice Sandile Ngcobo, has recommended the establishment of a dedicated supply side regulator of healthcare to regulate medical practitioners and determine tariffs.

The commission’s recommendations follow the release of two bills which will also overhaul healthcare in the country: the National Health Insurance Bill and the Medical Schemes Amendment Bill.

The inquiry looked into the constraints on competition in the private healthcare sector in a context of rising costs.

It found that overservicing by medical practitioners was one of the factors that has driven up private healthcare expenditure. This overservicing includes increased admissions to hospitals, increased length of stay, higher levels of care, greater intensity of care and the use of more expensive forms of care than necessary.

The recommendation on standard tariffs for medical practitioners was welcomed by South African Medical Association chairman Dr Mzukisi Grootboom, who said the association, which represents doctors, had been lobbying for this for many years. He emphasised, however, that the process of tariff setting would have to be fair, allowing doctors to be able to earn a reasonable return on their investments.

It was also important, Grootboom said, that the regulator be neutral and independent from the Department of Health.

Council for Medical Schemes acting registrar Dr Sipho Kabane welcomed the proposal to standardise medical scheme options as the multiplicity of options confused consumers. The council was developing a framework to guide the industry on the reduced number of options.