Health minister Aaron Motsoaledi has defended the government’s approach to implementing the Health Market Inquiry’s (HMI’s) recommendations, saying it was constrained by the Covid-19 pandemic and budget restrictions.
The government took its first steps towards implementing the HMI’s recommendations last week — more than five years after its final report was published. These measures were intended to relieve pressure on consumers “as an interim stop-gap measure” ahead of the implementation of National Health Insurance (NHI), Motsoaledi said.
The Competition Commission established the HMI at Motsoaledi’s request in 2014 to investigate the barriers to competition in the private healthcare sector. It published its final report in September 2019, in which it concluded the private healthcare market was characterised by high and rising expenditure, over-utilisation of services and lacked any credible measure of the quality of care provided to patients.
The Covid-19 pandemic struck in early 2020, and all government resources were then directed towards combating the impact of the virus, said the minister.
Trade, industry & competition minister Parks Tau published draft regulations on February 14 that pave the way for the establishment of a multi-lateral tariff negotiating forum, where medical schemes and private healthcare providers can set prices. The tariff-setting body is to be overseen by the health department and participating parties are to be granted a block exemption to the Competition Act’s prohibition on collective bargaining.
The health minister recently published draft regulations that propose establishing a uniform basic benefit package that must be offered by all medical schemes.
These measures deviate to some extent from the HMI’s recommendations, which said tariff negotiation should be overseen by an independent body called the supply side regulator for health. The supply side regulator was integral to its proposals, and was also tasked with advising on best practice, issuing facility licences and practice numbers, and liaising with a new body to monitor the quality of care, known as the Outcome Measurement and Reporting Organisation.
The health department previously said establishing the supply side regulator would require creating a new schedule 3a entity with an act of parliament.
Motsoaledi said on Monday that the Treasury would not support the creation of more schedule 3a public entities for health as they were costly structures. Government money should be spent on patients, not administration, he said.
Healthcare capacity planning, including licences, would be “firmly located” within the health department, said the minister. There would be no need for the health department to issue practice numbers, as under NHI every health establishment would have a unique master health facility list identity and healthcare professionals would have unique provider numbers linked to their professional registration numbers, he said.
Last week, former HMI panel member Sharon Fonn, a professor of public health at Wits University, said an intervention on tariff negotiation alone would not drive down the cost of private healthcare, as it needed to be combined with reforms to manage demand and measure the outcome of the care provided to patients. Implementing the HMI’s recommendations piecemeal would not foster competition or protect consumers, she said at the time.
Motsoaledi defended the government’s approach, saying the HMI never intended all its reforms to be simultaneous and work was under way to act on many of its recommendations.
For example, the health professions council of SA was in the process of amending the ethical rules prohibiting multi-disciplinary teams, a standardised benefit package was under discussion, and the health department had established a working group on health technology assessment, he said.
Motsoaledi said the Office of Health Standards Compliance could execute the functions of the Outcome Measurement and Reporting Organisation.
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