Hospitals have steadily increased their admission rates over the past five years for overnight stays and day procedures, suggesting the private healthcare market has systematically shifted towards treating patients in hospitals instead of doctors’ rooms, a report released on Thursday by the Competition Commission’s health market inquiry has found.
The commission established the inquiry to investigate the dynamics of the private healthcare market, and establish whether there are barriers to effective competition and patient access. Its report is the first in a series it plans to release in the coming weeks.
It has scrutinised five years’ claims data submitted by 80 medical schemes representing almost 95% of the market.
The finding of increased hospital admissions helps explain why medical schemes’ claims expenditure has grown far faster than consumer price inflation. The inquiry found medical schemes’ claims costs per beneficiary rose 8.59%-10.16% per year from 2010 to 2014, while CPI rose at 5%-6.1% over the period. Out-of-hospital costs rose 5.25%-9.33% per beneficiary per year in the period under review, while in-hospital costs rose 10.27%-11.4% per beneficiary per year.
The reasons for medical schemes’ increased spending on hospital bills is contested, with private hospitals attributing it to increased utilisation by an older and sicker population, along with advances in medical technology. Medical schemes have complained hospitals have created "supplier-induced" demand by providing more hospital beds than the population needs.
The inquiry said it had not received claims information from the medical schemes Genesis, Commed and Makoti — and other schemes had provided incomplete data. Inquiry director Clint Oellerman said they had helped many smaller schemes and administrators that lacked capacity to provide the data they had requested.
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