Monday, 30 September 2019

Cape Town: The Competition Commission yesterday released the report of the Health Market Inquiry with final findings and recommendations.

In a statement also issued yesterday, Mediclinic Southern Africa provided its initial reaction to the presentation of the final findings and recommendations report by the Health Market Inquiry (HMI) Panel, chaired by Justice Sandile Ngcobo.

“As one of the country’s leading private hospital groups, Mediclinic Southern Africa welcomed the opportunity to constructively participate in the HMI into the private healthcare industry and has from the start of the Inquiry been an active participant therein. Throughout Mediclinic’s participation in the HMI, it held the view that the solutions for the issues facing healthcare can be found through an inclusive and collaborative process. The implementation of the recommendations should support a more sustainable private healthcare environment,” said Koert Pretorius, Chief Executive of Mediclinic Southern Africa. 

The HMI has maintained that the private hospital market is highly concentrated. Mediclinic and other industry stakeholders submitted data analyses and research studies by expert competition economists to the HMI which clearly demonstrate that the HMI’s analyses and conclusions pertaining to market concentration are incorrect and outdated. Furthermore, the HMI’s findings did not indicate market abuse such as anti-competitive or excessive pricing and profits.

Mediclinic therefore supports the recommendation for the continuation of bilateral tariff negotiations between facilities and funders. Mediclinic also takes note of the recommendation to move away from fee-for-service tariffs to alternative reimbursement models (ARMs) where providers enter into risk-sharing arrangements, which is in line with Mediclinic’s strategy. For this to be fully implemented within the envisaged three years, the Health Professions Council of South Africa (HPCSA) ethical rules will need to be amended timeously.

Mediclinic welcomes the fact that the HMI has revised its preliminary stance on divestiture and/or moratoria on new licenses as contained in the HMI preliminary report of July 2018. In line with its submissions, Mediclinic notes that the HMI has found that there is no need to break up private hospital groups or to cap market share.

The HMI report recommends the creation of an Outcomes Monitoring and Reporting Organisation (OMRO) as a platform for providers, patients and all other stakeholders in the provision of healthcare to generate patient-centred and scientific robust information on outcomes of healthcare.

Mediclinic welcomes the recommendation for the establishment of such an independent, private organisation to generate relevant and standardised outcomes information. Quality outcomes information has been an ongoing issue as flagged by Mediclinic’s participative submissions in the HMI process.

Mediclinic welcomes the recommendation that health outcomes should be measured and reported upon for purposes of monitoring and benchmarking performance in a defined and standardised manner. This will provide patients, healthcare professionals and funders with greater transparency on clinical performance information. 

Mediclinic notes the HMI recommendation that a Supply Side Regulator for Healthcare (SSRH) be established with various functions relating to licensing, economic value assessment, a health services monitoring unit and health services pricing unit.

Mediclinic fully supports the view that this should be an independent body. Mediclinic will analyse the HMI’s recommendations carefully to understand the proposed functions of the SSRH.  

Mediclinic has more than 30 years’ experience in the private hospital industry and owns and manages facilities which have been inspected and licensed by the various provincial Departments of Health. Mediclinic is of the strong view that any licensing framework should be transparent and fair.

Some of the licensing recommendations appear to be onerous at first glance and Mediclinic will study the detail further to determine its impact and rationality. 

Mediclinic fully supports the recommendation that the HPCSA ethical rules require revision. The existing HPCSA ethical rules prohibit joint initiatives to develop new efficient and cost-effective care delivery models.

Models that allow for risk sharing, the development of ARMs, global fees, multi-disciplinary practices, employment of healthcare professionals and shareholding in corporate entities where parties wish to do so, should be encouraged. 

The collective development of innovative products and reimbursement mechanisms would greatly enhance the value of quality care delivered to patients. The prevailing fragmented South African healthcare delivery model is contrary to the manner in which healthcare is delivered in many other parts of the world.

In Mediclinic’s view doctor/hospital integration and working together to achieve better patient care and efficiencies should in no manner whatsoever, compromise clinical ethics and professionalism.

The HMI states erroneously that the three leading private hospital groups are able to distort and prevent competition by binding the best medical specialists to their hospitals with lucrative inducement programs.

Mediclinic supports cost-effective quality care and does not condone any treatment that is not in the best interests of the patient. In addition, Mediclinic does not condone any relationships between hospitals and doctors that does not meet our high ethical code of conduct.

“It is important to note that the market context has moved on since 2014; the end date for the majority of data used. Current data must be used to find current best solutions for the unique South African healthcare market, especially as South Africa prepares itself for the introduction of the NHI.” said Pretorius.

Mediclinic strongly believes that the private healthcare industry can play a valuable role in broadening access to efficient, quality healthcare in South Africa. Mediclinic is currently studying the detail of the final findings and recommendations against the backdrop of its desire to provide quality healthcare in the South African context. Read the statement.