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Medical aids to collude?

by
2008-04-03 08:00

Robert Beney, News24 User

There is very little that surprises me anymore.

Daily reading the news on how the people of South Africa are further burdened with increasing living costs and how the inept middle and senior management at various levels of industry, commerce and government continue to reap the benefits of excessive non-performance bonuses, is enough to drive one to seek out the miserable existence of those northern islands of our previous colonisers.

But a little Machiavellian move by the Board of Healthcare Funders must surely take the cake. For those who don't know who they are, I shall paraphrase. I think they are a greedy bunch of colluding lobbyists.

They of course describe themselves in much more flowery language as "... BHF is the representative organisation for 95% of medical schemes throughout South Africa, Namibia, Zimbabwe, Botswana as well as Lesotho. As the industry representative body, the organisation relies on the membership of all medical schemes to ensure that it is able to lobby government and other organisations effectively and to influence policy where necessary on behalf of the entire industry."

Now all in all this is legitimate legal entity, however there are surely ethical issues involved, especially in the light of a press release they issued in March of this year titled: "Application for exemption from the provisions of the Competition Act - 14 March 2008".

For those of you who didn't get that, I'll explain it a little more clearly. The BHF has applied to be excluded from the provisions of the competitions act. Which in effect is them asking for permission to collude on price fixing your medical costs.

Six of one, half a dozen of the other

Now their argument in favour of this is to be able to better negotiate hospital and supplier costs. Frankly I don't believe that is a valid vehicle for deal with this issue, instead the solution should be government dealing out a few snotklaps to hospitals and suppliers for exorbitant pricing, not giving medical aids free rein to milking Joe Public.

I doubt very much that strengthening the BHF lobby will reduce the pricing of medical costs on the supplier side. The only effective mechanism for that is for government to regulate the suppliers.

Now I am very much a capitalist, with a slight nasty socialist streak in me. So I believe in free markets et al. But government needs to remember that in a capitalist society their primary function is to guard over the interests of the population that elected them, not to have wonderful blissful nights on satin sheet covered heart-shaped beds in the arms of commerce and industry.

What is even more shocking about this application is that we haven't heard peep out of the media regarding it. A press release given out in mid-March and not a word? This is big stuff boys and girls, where are our investigative journalists?

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Gary 4/3/2008 8:16:39 AM
Do your selves a favour and go and watch Siko by Michael Moore. Cuba has a better medical system than America and South Africa is just like America in so much as how the government and private health care system rapes Joe public like ATM's.

HVR 4/3/2008 8:41:02 AM
They are probably already colluding. I'm paying R1000+ FOR HOSPITAL COVER ONLY for TWO PEOPLE at one of the biggest medical funds in SA. This is for 100% cover, I resently found out this is effectivly only cover between 25% and 33% of my hospital costs. Why was this communicated to me? THE SOLUTION: Force the medical funds to pay full price except for say a R500 excess. For around R500+ a month per person I CAN'T see how this is NOT financially viable

Kolobe 4/3/2008 8:43:38 AM
So socialism is not such a bad idea after all..wish that Vavi can read this...after the usual rant posted here againts Socialism then I wonder what really is good for the country..I thought capitalism was the best yet the current price hikes makes me wonder if Vavi and friends were not right after all..Currently the rich are becoming reacher and the poor are becoming poorer..Surely Capitalism is not working..

Pangea 4/3/2008 8:43:48 AM
It is bad enough our medical system in this country is a shamble, both private and public. The Public system is a shamble thanks to Manto's incompetance and now we are expected to fork out more for Private Health care that is already hugely expensive. So what happen to competition?

Cynicus 4/3/2008 8:45:03 AM
Good piece! I, too, am a free-market exponent/capitalist. My socialist streak (tiiiiiny one!) is tickled by this splendid example of corporate Doublespeak ((TM),G.Orwell). Small item that Joe Public needs to remember when dealing with private medical care - NEGOTIATE NEGOTIATE NEGOTIATE. Push for lower quotes on procedures, insist on cheaper alternatives for medicines ... and resist this nice little effort to collude!

bokkie 4/3/2008 8:57:21 AM
The equasion is quite simple. Pharmasuitacal companies produce medicines and then market them at a profit that will satisfy their shareholders. Private/semi-private hospitals provide patient services - ostensably to also make a profit that will satisfy investors and shareholders. Finally, there are the mdical aid companies which, yes you guessed it, are also driven by the same motive. If collusion will boost their primary motive, of course they will do it - just like the banks do!

May 4/3/2008 8:59:44 AM
My mother is a pensioner and she has a very basic medical aid. They interfere to such an extent in her care and treatment for diabetes that I have my doubts about whether its worth her having one. They tell the doctor what medicines she's allowed to have and what specialists she's allowed to see! Its also no surprise to learn that private patients are being charged more than what medical aid patients pay. My husband and cousin both work for MediClinic so I know just how greedily the private hospitals and medical aids collude. The government needs to put the breaks on them and definitely not by giving them more power than they already have!

Kolobe 4/3/2008 9:04:31 AM
My sentiments exactly, if Cuba a socialist state has the best Medical Aid in the world, then what are we doing with a capitalist state??..Maybe Zuma will not be bad with his Communist friends.. Can we then have a mixture of capitalism and Comminism...Help we are dying of price hikes...

saliem 4/3/2008 9:10:42 AM
We all need to make money somehow, so it is not fair to knock the medical aid companies. If you cannot afford it, go to public hospitals

lekkalik 4/3/2008 9:12:08 AM
If the government did what they're supposed to, then we really wouldn't need private healthcare!Its ridicululous that we should pay so much for (private) healthcare, but we're in a free market system & if government doesn't/can't deliver, private fills the gaps, just like its happening in security, police ineffecient so we have to pay for private security!Govt pull up your socks if you got any! socalism is also not the answer-too many indigent people here-who will cover that cost & at what cost?

John Camp 4/3/2008 9:19:11 AM
As medical cost soar and continue on this trend my advise to the consumer is to bargain with the service providers. I was recently quoted R20 000 for orthodontical work for my son, i requested a cash price which was somewhat less than the initial R20 000. So my advice (where possible) pay hard cash and claim back. The consumer is in a no win situation regardless of what we do, i agree that government should step in an regulate the industry.

Christiaan 4/3/2008 9:20:34 AM
My emotions run so high that it will be impossible to express them in this meager space that I am allowed here. I am paying close to R5000.00/m and still has to sit with unpaid bills and refusals. Why can't I just pay for this myself and stuff these guys?

Christiaan 4/3/2008 9:30:02 AM
Capitalism is about competition and socialism is about regulation. What we see here is a highly regulated environment but without a cap on hospital charges.

Helen 4/3/2008 9:36:15 AM
There is no such thing as a medical aid company. Medical schemes are non profit organisations and you get what you pay for. BHF is doing this to try REDUCE costs. Schemes currently do not have enough negotiating power with health providers at the moment and cannot join forces to negotiate lower costs because of competition legislation.

Dr Koos Marais 4/3/2008 9:36:50 AM
I am a fairly well known dentist with some strong views on the hated medical schemes. They are the source of most of our problems. They are the cause of over and under treatment and the destroyer of the doctor-patient relationship. We are raising a generation of doctors and dentists whose minds have been so warped and indoctrinated by the skewed views of the medical aid socialism that they have lost their primary focus, the patient.

psycobabble 4/3/2008 9:39:52 AM
with Cynicus and John Camp.One must negotiate and look for best alternative by "shopping around".Don't feel bad by the medical professions rightous indignation if you imply that you know they will rip you off given half the chance.I recently had an eye op at pvt hosp.They charged me 5000 for 15 mins in the op theatre.I made a big fuss about it and let them know my disgust.They've just rebated me 2350.Don't just give in!

Kolobe 4/3/2008 9:41:36 AM
Silly

psycobabble 4/3/2008 9:45:30 AM
Both have their pros and cons.I think we need a free market system coupled with social security.This unfortunately must come from govt. to whom a monthly contribution should be paid by citizens,much like UIF or RAF.We all know their record on security of any type especially their own let alone managing our funds!

Debbie 4/3/2008 10:02:04 AM
Helen is absolutely correct. The reason that doctors etc charge such high fees is that BHF were STOPPED from setting limits to what medical practioners were permitted to charge for certain services. It was claimed to be "Uncompetitive" The patient is now left with the bills!

aelric 4/3/2008 10:02:31 AM
if medaid schemes are non-profits why are some of these listed on the JSE?? furthermore as stated in the article, the solution is not to exempt BHF members from the competitions act but rather for the govt to tackle the suppliers. We did it with HIV drugs and generics..

Paul 4/3/2008 10:02:46 AM
Instead of wanting to give private hospitals a snotklap for "exorbitant" pricing, rather give that snotklap to the public health care system who is failing the taxpayer dismally. Do you know what it costs to run and equip a private hospital...I THINK NOT. Everyone always compliments the excellent service received at private hospitals, but moans when it comes to paying for the excellent equipment & care. If you have only R5 in your pocket...get out of Woolworths & go shop at Pep Stores.

Sel 4/3/2008 10:09:52 AM
Excellent points, Rob! The erosion of competition and competitive ethos is at the core of this rot--which is in turn fueled by the philosophy of entitlement, AA and BEE. More free lunches, bonuses and advantages to the racists. Kolobe's racist nonsense notwithstanding, all thinking South Africans will concur with your astute analysis. Only an end to racism will put an end to this scourge. I'm seeing that your views get maximum coverage overseas.

psyocbabble 4/3/2008 10:13:20 AM
Dr.Marias,you illustrate the situation perfectly.I see any health requiremant of mine now as a simple transaction.I don't expect compassion from practioners.I hate to say this but it seems the hippocratic oath has taken a back seat to cold hard business principles.

Hans 4/3/2008 10:13:49 AM
Regulation The Medical Aid market is not as straight forward as all that. It is currently the most stringently regulated part of the Private Health Industry. Medical Schemes cannot ? by regulation - make ANY profit. If the total claims is less than that budgeted for, then the reserves increase and next years premiums should not increase that dramatically. This is because there are more reserves to cover the claims. Medical Aids have NO SHAREHOLDERS. Cost Increases Steeply increasing premiums can be attributed to a few things: o If it is known to a provider that you have medical aid, chances are they?ll charge you more than they would have if you had been without medical aid. It, however does not apply to all providers. Hospitals mainly have their prices and will apply that whether or not you are covered. o People tend to use more and more medical aid services and demand that the latest technology treatments be available to them. These treatments/medicines are extremely expensive. o There are a lot of medical aids and because of this their bargaining power is fragmented and weak. The hospital industry on the other hand is dominated by three groups. There is therefore a mismatch of bargaining power and the medical schemes end up being price takers. (The Board of Healthcare Funders wants regulation to allow the medical schemes to have more power in price negotiations) o There are a few other things but it is of lesser importance. Solutions Regulation that physically interferes with the prices of services will only result in providers leaving the South African market and even less and lower quality services will be available. The way regulations should operate is only to promote competition between providers. Personally I would prefer that regulation force hospital groups to split into smaller groups and have fierce competition amongst them. Medical Schemes have no other income than that received in contributions. If you then have the attitude that if you don?t use it you lose it, you?ll just end up paying much more each year. If regulation forces the full payment of each medical bill, your premiums will double every few years. I suggest you thank the Lord that you are so healthy that you don?t need medical services and joyfully pay the contribution so that the less fortunate less healthy people can enjoy proper care. (Since socialism seem so attractive, that is the socialist thing to do) Blessings

saliem 4/3/2008 10:24:19 AM
So what's your point then? Capiche?

colin 4/3/2008 10:24:55 AM
Please media inform us why this was not BIG news ? the media has a mandate to inform the public not just to sell newspaper or maintain TV ratings. The media wasted our time on 1st of April with insignificant childish articles but forgot to spend there resources on a story as significant to the public as stated in the above article ? same on you MR EDITOR.

saliem 4/3/2008 10:31:08 AM
My point exactly. Pse take note Kolobe

HVR 4/3/2008 10:38:56 AM
I now there is a lot of treatments which uses expensive technology, but please explain to me the follwing bill at a private hospital ER. Two stiches, two standerd injections, 5 min of the docters time, 1 pressure bandage, 1 standerd bandage. Total R690.

John Camp 4/3/2008 10:52:31 AM
I agree with what you say, perhaps you can confirm another point about Medical aids. Apparently they can take up to 180 days to pay a claim hence doctors charging patients upfront and making the problem of collecting funds the consumers problem?? This i disagree with because it takes away the bargaining power from the consumer because everything becomes cash for the service provider.

bokkie 4/3/2008 10:54:54 AM
Ask for a refund... on the medical bill and for your spelling lessons.

John Camp 4/3/2008 10:57:08 AM
I agree with the concept of "National health" however it won't work in South Africa just yet. I think the government should adopt a 50/50 scheme whereby consumers can join a state medical aid with consumers paying reasonable contributions. This will plough very much needed funds into the system needed for development of institutes and professional services.

Kolobe 4/3/2008 10:58:52 AM
One stich cost R100 each,that makes your two stiches R200, two standards injections R200,the doctors charges a consultation fee of R200.the bandages costs R45 each,that my friend makes R690,you received a discount for the bed,tea and administative costs..Please be happy:)

Debbie 4/3/2008 11:10:58 AM
People, please read your membership docs from your medical aid! If you have a Hospital Plan only, virtually the whole contribution goes to your medical aid. If you have a savings portion attached, the government regulates that only a certain percentage ? 15% /25%? of your total contribution may go towards a savings facility: THE BALANCE goes to the Managed Healthcare company paying your bills! It is Admin fees.

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