Opinion divided on medical aid price regulation

Council for Medical Schemes (CMS) spokesperson, Dr Elsabé Conradie, says having no pricing guideline is not benefitting the healthcare industry.

Industry agreements on prices were outlawed by the Competition Commission which insists individual medical schemes and practitioners must negotiate prices to boost competition.

The CMS 2015-16 annual report is vocal on the lack of guidelines: “The vacuum left because of no price regulation within the private healthcare sector where providers are charging above medical scheme rates, places an onerous burden on the already hard-pressed South African healthcare consumer.”

Chair of the SA Medical Association, which represents practitioners, Mzukisi Grootboom says competition law changes are needed to to enable a bargaining council, where government is aware of all costs to be considered in doctors’ fees, before it decides on setting them.

In the current context, provider fees will need to be capped in future, says Patel. “The department of health needs to step in to protect consumers and to provide clear guidelines for alternative reimbursement models for providers.”

The BHF hopes the HMI will recommend a regulated maximum pricing framework. The HMI’s findings are expected in December 2017. But not everyone agrees. At an October 2014 Hospitals Association of SA conference, former UK CompCom deputy chair Peter Davis said price controls could create potentially-damaging distortions to the market; be costly to implement, monitor and enforce; and should be a last resort.

“The interconnected nature of the entire healthcare supply chain emphasises the need for a strategic approach that involves all role players to find a way to standardise benefits in a manner in which we can measure the quality and cost of care, and in turn use the outcomes data to better define the future healthcare model for the country,” says Board of Healthcare Funders chairperson Dr Ali Hamdulay. – Business reporter