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Regulating Private Healthcare – Where are we now?

March 29, 2018

Our Chartered Employee Benefits Healthcare Specialist, Paramesh Dayaram, updates us on the current healthcare inquiry, initiated by the Competition Commission, and what it means for the consumer.

In 2014, the Competition Commission began its inquiry into Private Healthcare.  Its mandate was to determine the barriers to competition and to consumer access.  As such, it aimed to “implement measures to increase market transparency”. The Commission initiated the inquiry in the belief that there were features of the sector that “prevent, distort or restrict competition”.

The proposed date for the draft report was August 2016, but it was only in December 2017 that the Commission published a series of analytical reports, with 15 December 2017 being the proposed publication date for the Final HMI report and recommendations.  Now, the final report and recommendations have been scheduled for later this year. March 2018 has been earmarked for seminars covering proposed regulatory interventions for the licensing of healthcare facilities.

Why is it important to you, the consumer?
With the concern about the quality of care offered by the public sector healthcare providers, consumers are increasingly turning to private healthcare providers; however, this sector is not as regulated as it should be – hence, this Healthcare Market Inquiry initiated by the Commission.

There is no doubt that private medical care has a place, but the industry is riddled with complexities and jargon.  So, can this sector be more transparent?  Can moves be implemented to regulate it? Are private hospitals driving up healthcare costs, thereby being responsible for a significant portion of the above-inflation increases in expenditure reported by medical schemes?

Important for consumers is the debate about cost:  should there be a limit to what one has to pay for the best treatment? In fact, what constitutes the ‘best’ treatment?

The ideal must surely be reaching a point where the average consumer is fully educated on the total package he or she has purchased: service and product.

Focus on industry, not individual companies

Advocate Clint Oellermann, Director of the Healthcare Market Inquiry, says, “Firstly, it must be understood that a market inquiry is a general investigation into the state, nature and form of competition in a market, rather than a narrow investigation of specific conduct by any particular firm.”

Oellermann’s comment speaks to the scope and magnitude of this investigation which has been, and continues to be, a consultative process with the many stakeholders within the sector.

Looking forward … 

We at Chartered Employee Benefits are awaiting the final report and will provide comment when it appears.

For now, when those poolside conversations spout words such as “shortfalls”, “co-payments”, “deductibles”, “PMBs” and “wrong procedure codes”, be assured that there are processes underway to simplify the concepts and make the jargon more understandable … all towards a more effective industry and a more satisfied client.

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