PRIVATE HEALTHCARE MARKET INQUIRY REPORT: IMPLICATIONS FOR NHI

This article was published on 4 October 2019 in the Law Society of SA Legalbrief Weekly, an initiative of the Law Society of South Africa & Juta Law

Recommendations in the recently released Competition Commission’s health market inquiry report were made with the aim of providing a better-functioning environment for national health insurance (NHI). According to the report’s executive summary, this is noting that NHI implementation ‘is some years away’ and that the fund proposed in the 2019 NHI Bill is ‘scheduled to be operational by 2026 at the earliest’. The six-year inquiry found the private healthcare sector to be ‘neither efficient nor competitive’ and characterised by low levels of ‘value-based purchasing’, poorly regulated practitioners and accountability ‘failures’ at many levels. In the panel’s view, this has left consumers ‘disempowered and uninformed’ – especially in the prevailing ‘highly concentrated’ funder and facilities markets. The Department of Health is partly to blame, not having used its ‘existing legislated powers’ to conduct the ‘regular reviews … required by law’ and hold regulators ‘sufficiently accountable’.

Key recommendations include establishing a supply-side regulator (among other things to formulate a ‘needs-based system of licensing’); making a standardised, single benefit package a mandatory medical scheme option; introducing a risk adjustment mechanism (among other things involving income cross-subsidisation and disincentivising risk-based competition between medical schemes); and putting in place a ‘reliable outcomes measurement system’ (allowing consumers to compare and select healthcare providers, and funders to contact those offering value for money). In addition, the report calls for changes in the ‘ethical rules’ of the Health Professions Council of SA (to promote ‘innovation in models of care’ that allow for ‘multidisciplinary group practices and alternative care models’, ending the dominance of the fee-for-service payment mechanism); the development of guidelines for health professional associations (‘to ensure that they are not at risk of potentially anti-competitive behaviour’); and compulsory training for undergraduate and postgraduate students on the cost implications of healthcare technology and the impact of health system financing models on patients’ healthcare choices.

While President Cyril Ramaphosa’s remarks at the health sector anti-corruption forum launch this week tended to point to a focus on the plethora of illegal practices bedevilling state-run healthcare institutions, he nevertheless noted the importance of curbing ‘false invoicing, collusion and price fixing’ by private service providers. Also speaking at the launch, Justice & Correctional Services Deputy Minister John Jeffery said the Council for Medical Schemes has estimated that private healthcare system fraud amounts to ‘approximately R22bn annually’. According to Health Minister Zweli Mkhize, ‘over-servicing’ consumers and ‘over-pricing’ products in some markets are the ‘big issues’ requiring attention as his department rolls out NHI (Engineering News).

Meanwhile, the National Assembly’s Health Committee has extended the deadline for written submissions on the NHI Bill by seven weeks – to 29 November. This will allow ‘important’ healthcare delivery stakeholders two weeks more than they requested to prepare input in anticipation of parliamentary hearings likely to be held next year – although no dates have been announced. The decision may have been influenced by recommendations in the Competition Commission report, which committee chair Sibongiseni Dhlomo believes point to the need for government intervention. Public hearings in all nine provinces are scheduled to begin on 25 October in Mpumalanga, followed by the Northern Cape on 1 November.