A competition Commission probe into private health care has been welcomed by dentists, who say that medical aid administration and broker commissions are driving up tariffs at a time when below-inflation payouts are putting them out of business.
This week the approval of legislation giving the commission the power to investigate different industries meant an investigation into private health care was imminent.
The commission’s Trudi Makhaya said the legislation was expected to take effect from April 1.
Maretha Smit, chief executive of the SA Dental Association, said the investigation into private health care was in the interests of dentists because medical schemes paid minimum rates, but member costs were being “driven” by soaring administration costs and broker commissions.
SA Medical Association research shows that of the R93.2 billion spent by schemes in 2010, R34.1bn went to private hospitals and R12.1bn to costs such as administrator and broker fees.
Medical specialists received R21.3bn, but general practitioners and dentists were paid R6.8bn and R2.6bn respectively.
Elsabe Conradie of the Council for Medical Schemes said she could not respond to The Mercury’s questions, but Smit said dentists were not being adequately reimbursed because oral hygiene was low on medical aid priority lists, yet set-up and equipment costs were exorbitant.
As a result about 4 percent of dentists were leaving the country each year, and the drop in medical aid members getting their teeth checked because of inadequate benefits was “unnerving”, she said.
In last year’s Council for Medical Schemes report, payouts to dentists and dental specialists were shown to have declined from 8.4 percent in the 1990s to 3.5 percent last year.
Smith said that translated into as little as 0.4 percent of medical scheme beneficiaries visiting a dentist at least once year. “This is while 41 percent of women and 31 percent of men suffer from oral disease in South Africa,” she said.
These statistics, Smit said, underscored the urgent need for medical aid schemes to give dentistry higher priority.
“The man in the street is putting dentistry low on the list of essential needs.”
One Durban dentist, who asked not to be named, said medical aid increases to the sector had remained at 5 percent for the past few years.
“Our problem is equipment and material,” he said. “They are all imported from Germany and the US. With the rand-dollar exchange rate, and medical aid increases not keeping up with inflation, it makes dentistry very expensive.”
He said it was not economically viable to use medical aid tariffs.
Jimmy Mthethwa, the head of the oral health unit at the KZN Health Department, said that a major shortage of dental staff and facilities in rural clinics was “worrying”.
“Yes, I am aware of the links between gum disease and other diseases, such as cardiovascular disease. We are very concerned. We are in talks with the University of KwaZulu-Natal to get more oral hygienists trained. We are offering bursaries.”
He said district clinic dental facilities would be well equipped by 2015. “We have to change our focus to preventive medicine, and that’s what good oral hygiene does.”
UKZN’s Indu Moodley said student numbers would increase once a new oral and dental school opened in 2015.