A coalition of healthcare professionals has urged the government to abandon its plans for a collective bargaining scheme for private healthcare providers, saying its proposal is legally flawed and won’t reduce costs.
Last month, trade, industry and competition minister Parks Tau published draft regulations to the Competition Act that propose granting medical schemes and some private healthcare providers an interim block exemption to the act’s prohibition on collective bargaining. The draft regulations, which exclude private hospitals, also propose establishing a multi-lateral tariff negotiating forum overseen by the health department.
The United Healthcare Access Coalition (UHAC), representing 34 healthcare organisations, said on Thursday the scheme had not been properly thought through and was at odds with the recommendations of the Competition Commission’s Health Market Inquiry (HMI).
The HMI’s final report proposed a set of inter-linked reforms that in addition to establishing an independent tariff negotiating body included interventions to manage demand, equalise risk between medical schemes, and monitor the outcomes of care.
“You can’t cherry pick which parts of the HMI you want. If you introduce a partial approach, it is going to have a negative effect on all of the features of the market the inquiry identified as problematic,’ said UHAC steering committee member Alex van den Heever, from the Wits school of public governance.
Managing health policy with an exemption to the Competition Act was a “highly questionable” approach and likely open to legal challenge, he said.
The regulations gazetted by Tau on February 14 introduce a framework to assess treatment protocols, health technology and the quality of care, which goes beyond the scope of the Competition Act, he said.
“These are health policy issues, which fall squarely under the jurisdiction of the minister of health, and have nothing to do with trade, industry and competition. It is the minister of health who needs to establish a positive legislative framework to implement the recommendations of the HMI,” said Van den Heever.
The UHAC said the block exemption approach should be scrapped and the HMI recommendations implemented in full, including establishing an independent regulatory authority to oversee expeditious tariff-setting, with a structured multi-lateral negotiating body to ensure transparent and binding tariffs.
SA Private Practitioners Forum chair Simon Strachan, also on the UHAC steering committee, said the tariff setting mechanism should include hospitals as they are a significant contributor to healthcare cost inflation.
The health department was refusing to establish a permanent system to manage and regulate private healthcare because it was intent on implementing National Health Insurance (NHI), said UHAC steering committee members Aslam Dassoo, convener of the Progressive Health Forum.
“It is working on the assumption that somehow in three years’ time we will have a completely new healthcare system that replaces both the current public and private systems, and pays for everything. This is implausible. It is not going to happen,” he said.
The UHAC is opposed to NHI, which it says is unworkable and unaffordable, and last year submitted an alternative proposal for health reform to President Cyril Ramaphosa.
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