Plea for more generous medical fee negotiations

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<a href="">Shutterstock</a>

Cape Town - The debate about high private hospital costs and who is to blame continued on Fin24 with users adding their voices.

Fin24 reported on Wednesday that Bonitas scheme has hit out at the largest private hospital groups over the high costs.

According to Dr Bobby Ramasia, principal executive officer of Bonitas Medical Fund, the second largest open medical scheme in South Africa, the three largest hospital groups in the country, Netcare [JSE:NTC], Life Healthcare [JSE:LHC] and Mediclinic [JSE:MDC] all declared year-on year profit increases of between 17.8% to 25% at the end of their most recent financial year ends.

Read Netcare and Life Healthcare's response on the debate

Mike Duly, spokesperson for Bonitas, said on Thursday "we are all aware that private healthcare is becoming increasingly unaffordable to the man in the street".

"This phenomenon is being driven by a number of factors, which the Competition Commission Inquiry will indeed investigate."

In his e-mailed response to the initial story on hospital costs he said hospitals account for the largest portion of total healthcare costs - 35.3% according to a report by the Council for Medical Schemes report issued this week.

"In the context of increasing profits being generated by hospital groups, Bonitas is asking hospitals to reinvest a portion of those profits by being more generous during fee negotiations with medical schemes," said Duly.

"After all, 80% of patients served by hospitals are members of private medical schemes, who fund the costs. We are serving the same customer base."

If healthcare professionals, hospitals, medical schemes and patients work together, Bonitas believes healthcare costs can be controlled collectively, he said.

Broker commissions

Another Fin24 user Jacques (a medical doctor) blamed high hospital costs on broker commissions.

He wrote: "Last year the total spend by medical aids to hospitals was equal to the total paid in commissions and admin fees to its brokers.

"This was also five times as much as what was spent on all the general practitioners in all disciplines.
"When last have you heard of the schemes trying to save costs by cutting broker commissions?

"Who drives the better car? Your GP or your broker?"

Look into specialists

Another Fin24 user, who did not give his name, pointed a finger at specialists, saying they should be investigated.

"It is not so much the hospitals. The specialists should be looked into," the user wrote.

"They charge patients far too much. They are in the game for the money only and not for helping the patients."

Better in Zimbabwe?

Fin24 user David compared SA's medical costs to those in Zimbabwe. He wrote: "It's surprising that the medical scheme contributions are so high in SA.

"While working in Zimbabwe, medical aid was so affordable that almost every other worker was a member.
"There obviously is a way around making medical aid affordable to at least the average worker upwards."

Bad experiences

Fin24 user Roger said the real problem with hospital costs is that the total clinic cost is fragmented.
"The patient has absolutely no control over the costs, neither does the funder.
"It starts with a per diem (per day) rate for your level of care and multiple specialist fees, which vary depending on your condition, e.g. PMBs (prescribed minimum benefits).

"May be an anaesthetist, the pathology tests often ordered as part of routine protocols and of course sufficient radiology, X-rays and scans. Nearly forgot all the medication - all this may not be paid forby the funder (medical scheme).
"It may be that if funders add up all the multi-disciplinary costs associated with a hospital stay, it constitutes over 75% of their total expenditure, not 40%."

He noted another issue, that the clinics and doctors substantially mark up on all consumables and surgical devices, for instance cardiac stents.
"Most patients admitted to a private clinic, who belong to a top  benefit option, will end up paying what are loosely described as 'out of pocket expenses' when they are discharged.
"The next step, over the next month, is fighting with your funder to try to recover your personal expenditures and dealing with doctors' balanced billing accounts."

He said all these are his personal multiple experiences.

Fin24 user Alfred said we should not lose sight of fact that the right equation is Healthcare Provider = Patient + Medical Scheme. "It is not Medical Scheme = Healthcare Provider + Patient."

- Fin24

Disclaimer: All articles and letters published on MyFin24 have been independently written by members of the Fin24 community. The views of users published on Fin24 are therefore their own and do not necessarily represent those of Fin24.

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