Private medical industry under fire

The private healthcare industry has come under fire in a far-reaching inquiry – does this mean financial relief is on the cards for the public?

SHE nearly fell over backwards when the account arrived. Her bill for the treatment she’d needed was R24 000 – and that was just for the initial examinations. “The doctor’s tariff was 500% more than the regular medical tariff,” Joan Malan recalls. “And he wanted it paid within 30 days.”

The specialist the Hermanus-based 67-year-old had consulted was a gastroenterologist and the exorbitant amount she was expected to cough up astounded and shocked her – especially because she knew none of this would be covered by her medical aid.

She consulted a lawyer and made an arrangement to pay off the bill in monthly instalments.

“They weren’t happy about it but I paid them monthly from May last year until January this year. I really thought it was daylight robbery.”

Another shock awaited Joan when she needed new glasses. “When I went to pick up the glasses I discovered my medical aid had paid only R2 200 and I had to pay R3 400 out of pocket. It was almost too much for me.”

Anyone with medical aid will no doubt feel Joan’s pain. For years consumers have been complaining about the high cost of private medical care – and this was one of the main reasons the Competition Commission of South Africa launched its Health Market Inquiry (HMI) into the cost of private healthcare.

A provisional report on the HMI’s findings and recommendations was recently released – and it has wide-reaching implications for the industry. Dare we hope that more affordable private care is a possibility in the future? And what exactly did the inquiry find? We try to make sense of it all. DOES THE HMI HAVE ANYTHING TO DO WITH THE NHI? Health minister Dr Aaron Motsoaledi has often referred to the high cost of private medical care whenever the issue of the proposed National Health Insurance (NHI) is raised. And now that the issue is back in the spotlight, many South Africans wondered if the competition commission’s investigation was meant to pave the way for the NHI.

But it’s pure coincidence that the report was released now, says Paula Armstrong, a senior economist and healthcare expert with the Western Cape consultancy group Econex. The commission launched the inquiry four-and-a-half years ago and was supposed to present its findings in November last year. But the three largest hospital groups – Netcare Limited, Mediclinic Southern Africa and Life Healthcare – threatened legal challenges if they weren’t first given enough time to examine the data used to make the findings.

The commission believes these concerns have been dealt with now, which is why the report has been made public.

‘The doctor’s tariff was 500% more than the regular medical tariff’

WHAT EXACTLY DID THE COMMISSION LOOK INTO? The investigation, led by former chief justice Sandile Ngcobo, was launched out of concern about the high and ever-increasing cost of private medical care in South Africa.

The report states that medical aids are becoming unaffordable. And there’s concern about the fact that specialists and healthcare facilities are concentrated in