The Department of Health's long-awaited response to the Competition Commission's Health Market Inquiry (HMI) report includes a proposed uniform pricing structure for private healthcare services, and amending ethical rules to facilitate multidisciplinary healthcare teams.
But some of its suggestions were last week slammed by some members of Parliament's Health Portfolio Committee, where the department presented its feedback to HMI report.
Presenting its response to the committee, Deputy Health Minister Dr Joe Phaahla described the recommendations as “transitional interventions” that could mitigate the “current situation”.
Committee chairperson Dr Sibongiseni Dhlomo highlighted the urgent need for reform in the private healthcare sector to address the high costs and inefficiencies identified in the inquiry. He stressed that the findings of the HMI report reveal significant barriers to accessing quality healthcare, ultimately affecting patient outcomes.
The link between the HMI report recommendations and the NHI Act “must be appreciated” to ensure uniformity in approach and policy coherence, he said.
A parliamentary media stated said the committee noted the emphasis placed on the regulatory shortcomings that currently exist within the healthcare framework. "Some committee members stated that the need for standardised licensing processes across provinces was particularly pressing, as inconsistencies have led to significant disparities in the operation of private hospitals."
"Some committee members highlighted the necessity of a uniform pricing structure to mitigate patients’ high costs when accessing private healthcare services. In response, the department acknowledged this challenge and proposed the creation of a multilateral negotiating forum to develop reference pricing for services. This initiative would enable collaboration between medical schemes and healthcare providers in negotiating fair costs."
Members of the committee addressed the functionality of multi-disciplinary teams within the healthcare system, particularly the requirement for inclusive participation from all relevant healthcare professionals, the statement noted. "The committee strongly supported establishing multi-disciplinary healthcare teams, stressing that effective collaboration among various healthcare professionals is essential for delivering comprehensive patient care. The department affirmed the critical nature of multi-disciplinary teams for delivering comprehensive patient care. It indicated that efforts are underway to amend ethical rules to facilitate collaboration among diverse healthcare providers."
"The committee raised concerns regarding the need for a standardised licensing process for private hospitals across various provinces. The department articulated its commitment to developing uniform guidelines and using existing legislative frameworks to establish a consistent licensing process to enhance transparency and accountability."
"Regarding the proposal for a Health Technology Assessment (HTA) unit, the committee welcomed the initiative as a crucial step towards ensuring that healthcare interventions are evaluated for their economic value, promoting cost-effective practices.
"Additionally, the committee members questioned how health outcomes would be monitored to ensure accountability within the healthcare system. The department outlined plans to establish formal mechanisms for measuring health outcomes, linking funding to performance metrics to promote quality care across the sector."
However, reports News24, a critical Dr Kgosi Letlape of ActionSA – and a former president of the Health Professions Council of SA (HPCSA) – pointed out that the document was dated, and compiled after the release of the HMI report, which found the private sector was neither effective nor competitive in 2020, shortly before Covid-19 hit.
Deputy Director-General Dr Anban Pillay said the “strategic thrust” of the response to the HMI report was to “locate the interventions within the context of the NHI Act”.
He added that currently, there were limited outcomes measurement in the public and private healthcare sector, and that “it is notable that the health sector globally is reimbursed based on service, not on the outcome, which results in a perverse incentive for not achieving outcomes”.
“Under an NHI system, data would be routinely available as this would be part of the electronic patient health record.”
Letlape, however, warned the government to “tread carefully”, referring to its multibillion-rand expenditure on medico-legal claims and litigation.
“Be mindful of what you may be creating,” he said. “Because when create a paper trail saying your outcome was insufficient, what do you think the patients and lawyers are going to do with that? You would have documented insufficient treatment.”
He said such a plan would have to be “structured properly” to provide quality service and not a litigation “trap” that used the system as proof of inadequate care.
In his presentation, Pillay referred to the HPCSA’s ethical price rules being revised and updated to accommodate multidisciplinary teams (MDTs), which Letlape said raised questions about answerability.
“When you are going to be seen by MDTs, where’s the accountability? Who does what? And has anybody looked at the issues of ransacking?
“If we form a multidisciplinary team of specialists, we’re going to circulate (you) among everybody, and your funds will be depleted in no time. Where are the protections for that?” he asked.
He added that “this notion of multidisciplinary teams must be taken seriously because part of the issue has been about the insistence of the private sector wanting to employ doctors”.
“And once they do that, the doctor’s clinical independence and accountability is in jeopardy. When you work for corporate, it’s corporate interests that comes first. How do we balance the ethical responsibility of putting patients first?
“We’ve seen challenges even in the public sector: when doctors put patients first, they’ve been disciplined by the Department. They’ve been threatened with being fired. You now want to put them in the clutches of the stock market.”
He said the Competition Commission made a mistake in interfering in an area it shouldn’t have.
“That’s why we have this mess of pricing. They are now fiddling in areas of competence, and you will end up with an even bigger mess than what you currently have. I was a member of the HPCSA for 11 years. And what you see there is the constant determination to destroy the medical profession."
Regarding pricing, Pillay said the inquiry’s recommendation for a multilateral negotiating forum with a national maximum fee for service (FFS) tariff for prescribed minimum benefit conditions and a reference tariff for non-PMB conditions was “not an entirely new proposal”.
In 2010, the department had published a discussion document on this type of forum and private providers had rejected the proposal, he said.
“Interestingly … they now seem to support the HMI recommendation.”
The inquiry probed the healthcare industry in depth before making several recommendations to enable the overburdened public sector to leverage and benefit from the heavily resourced private sector with excess capacity.
It had also backed low-cost medical schemes that could inject millions more into private healthcare, relieving the burden on the public sector.
The Council for Medical Schemes, however, turned down applications for these schemes because it believed they would undermine a future NHI.
Deputy Health Minister Dr Joe Phaahla told the committee the Department had accepted the HMI’s findings, and their recommendations were “transitional interventions”.
“We do not agree with the commodification of health … we would want to move from the current dominant system of commodification to health as a public good. But we acknowledge that the HMI investigation was premised on the basis of ever rising costs of private health.”
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