Johannesburg - The private health-care sector had to stop “making noise” and start tackling the real issues in order to solve its cost problems, medical experts have advised following the recent spats between some medical schemes and doctors.
Just more than a week ago, Genesis Medical Scheme lashed out at the country’s big medical aids for “moulding statistics to present an inaccurate picture”.
The country’s biggest medical scheme, Discovery Health, has found itself in the firing line a number of times in the row over costs. It has been accused of not paying doctors enough and its suggestions last week that doctors should work in teams and be paid accordingly was fiercely criticised by the SA Medical Association, which said it was not the scheme’s place to suggest that.
In response to the accusations, Discovery Health chief executive Jonathan Broomberg said it was only natural that the biggest medical scheme in the country would “attract the lightning”.
“Everybody is looking for the crook. Everybody is looking for a scapegoat. Who can we blame?” Broomberg said.
“There are ways out of this difficulty. But they are not by hunting around for the guilty party. I believe that all parties in the system are actually acting in good faith and the question is how we can change the system together to make it more affordable.”
Alex van den Heever, a health economist at Wits University, said that the industry’s issues had been obscured by noise, which disguised the true picture of what was going on.
“This blame shifting, insulting each other, is just shifting the focus from the real issue. We need a process that gets to the root of the problem, like the market inquiry,” he said.
He said medical schemes made pronouncements because they did not want to upset doctors, while doctors were making accusations to shift the blame.
At every forum and conference, debates on costs in the private health-care sector have tended to focus on which sector has been making the largest profit out of consumer contributions to medical schemes.
Mariné Erasmus, a health economist at Econex, said as the finger-pointing continued, people had been using statistics to favour themselves. “Statistics are quoted selectively. Jargon is easily used to confuse because people are not always talking about the same thing.”
Erasmus blamed regulatory shortcomings for this blame shifting. She said although the Health Professions Council of SA had recently published the proposed process for determining the fee norms that could be used to settle complaints of overcharging, a more “complete” regulatory regime would be beneficial for the consumer.
“If appropriate regulations are in place, market forces should be left to respond in order to determine the most optimal economic outcome. But there are some gaps in the regulatory framework at the moment,” Erasmus said.
Private insurance in most other markets was underpinned by three pillars of regulation: open enrolment, community ratings and mandatory cover, she said. In South Africa the third pillar was missing. - Business Report