Private health-care’s excesses laid bare
OVER-SERVICING by doctors, specialists and other medical practitioners is among factors identified leading to soaring private health-care costs.
This is according to the Competition Commission, after it undertook a health market inquiry into private health-care costs, as well as the operations of medical aid societies amid increasing expenditure and higher costs of private health care in South Africa.
Inquiry leader Sandile Ngcobo said: “We have found evidence of supply-induced demand. Absolute age-adjusted hospital admission rates increased significantly from 2010 to 2014, and were higher than all but two of 17 countries compared against.”
There were, in some cases, unnecessary admission of patients to the intensive-care unit, an increased length of stay, higher levels of care and the use of more expensive forms of care than necessary, it was found.
“Specific discretionary surgical procedures were compared against comparable countries, and utilisation rates in the private sector were higher than the average for six of the seven procedures studied, and the highest of all countries for four out of seven,” Ngcobo said.
The commission also found it was difficult to assess whether private health care provided better quality care when compared to the public sector. This is because the country’s private market does not have any standardised means of measuring and comparing the quality of health-care services or outcomes.
“Practitioners are usually the point of entry into the health-care market. Due to their superior health-care knowledge, they act as agents.
“Practitioners are able to influence health-care expenditure through diagnoses and treatment, and through the services and treatments they recommend, which include referral for further investigation, treatment and hospitalisation.”
The report also found some rules of ethics of the Health Professions Council of SA (HPCSA) needed investigating as they conflicted with competition rules.
“It is our view that the HPCSA is not sensitive to the benefits of competition in creating incentives for affordable and quality care,” said Ngcobo.
The report has blamed hospital groups for the soaring cost of private health care, saying they engaged in uncompetitive practices with medical practitioners.
Ngcobo said stakeholders confirmed that facility groups competed to attract practitioners – specialists in particular.
“There is little need for explicit or formal collusive agreements; there is alignment of interests between facility and practitioner, where both stand to benefit from higher treatment volumes and intensity.
“The patient assumes these arrangements are to his/her advantage.”