The long-awaited Competition Commission inquiry into private healthcare kicked off this week with an appeal for prices to be regulated

“The current absence of an effective framework for price regulation compromises patient’s rights to high quality, affordable health care services,” according to public health organisation Section 27.

Section 27’s Umanyana Rugege called for “fee norms” to be published by the Health Professions Council of SA (HPCSA) as patients were unable to “complain about overcharging by health professionals” if standard fees were not set.

Section27 also said there was “widespread non-compliance with the coverage that all medical scheme members are entitled to by law, without any co-payments”.

Ivan Evans, a member of Bonitas medical aid scheme, was diagnosed with HIV in 1999 and he has been on antiretroviral (ARV) treatment since the early 2000s. He has developed a painful side effect from his ARVs called lipodystrophy, which causes fatty growths to develop on his back and neck.

As a result, Evans experienced headaches, back pain and impaired sleep and his doctor recommended the surgical removal of the accumulated fat around his neck.

However, Bonitas declined to approve the surgery even though he was entitled to it in terms of his benefit option. Only after Section27 took on Bonitas was Evans able to get back the money he had paid for the surgery.

Lauren Jankelowitz, CEO of Southern African HIV Clinicians Society, said doctors also battled to deal with medical aid schemes as cover for HIV and coding was confusing.

Meanwhile, Health Minister Aaron Motsoaledi said the price of private health was very high: “ The prices are above what the citizens of South Africa can afford. I have been saying so without any apology for years,” said Motsoaledi .

He added that the Board of Health Care Funders, which represents 80 percent of the medical schemes in the country, wrote to him as far back in 2010 to complain that the medical schemes’ prices were rising above inflation year after year, and this was unaffordable.

“We used to have 140 medical schemes in this country a decade ago but today we only have 83,” said Motsoaledi.

The Competition Commission has initiated the inquiry because it “has reason to believe that there are features of the sector that prevent, distort or restrict competition”. Public hearings will be conducted until early March and the commission is expected to table its recommendations by December.

Health-e News