How your doctor is ripping you off

Medical specialists are charging up to 300% more than the amounts that medical aid schemes allow.

This and other allegations are contained in a submission that the Board of Healthcare Funders (BHF) will make to the Competition Commission’s inquiry into the private health industry.

City Press’ sister publication, Rapport, has obtained a copy of the BHF submission, which pulls no punches.

The board says in its submission that specialists’ fees – especially those of orthopaedic surgeons, cardiac and lung surgeons, anaesthetists, oncologists and pathologists – are sometimes up to 300% higher than medical aids allow.

It also shares serious concerns about how doctors and private hospitals set out patients’ accounts.

For example, the submission includes hospital and specialists’ accounts that show patients sometimes pay twice for the same procedures.

It works like this: The account of a patient who had a knee replacement operation showed he had to pay for a “total knee replacement”, as well as for each individual procedure for a knee replacement.

Another account shows a patient had to pay for a “total nasal reconstruction”, and for all the separate procedures involved in a nose reconstruction.

The board also implicates hospitals in its submission.

One middle-aged patient’s account shows he was charged more than R3?000 for an “age indicator” and for a code listed as “multiday surgery” – even though his operation was done on just one day in a hospital belonging to a large private group.

The submission also includes figures from a study showing that between 2008 and 2012, specialists’ fees increased by between 15% and 18% every year – up to as much as three times the average rate of inflation.

The BHF also argues that Life, Medi-Clinic and Netcare, the country’s three largest private health groups, dominate the market to such an extent that there is no real competition in the sector.

It says in the submission: “One hospital group threatened a medical fund with a double-digit price increase unless the fund designated the hospital group as its preferred service provider.

“The BHF can confirm that a second medical aid was charged a 13% increase by the same hospital group but that it was reversed when the fund signed a [preferred service provider] agreement with the hospital group.

“All they care about is to ensure high returns for their shareholders’ investments. From 1998 to 2007, the return on investment in private hospitals rose from 10% to 20%.”

The Netcare Group says its submissions to the Competition Commission’s inquiry refute any claims by the board that the company’s prices are unreasonable.

“Netcare believes it is inappropriate that any of the parties [participating in the inquiry] should leak information about their submissions,” says Melanie Da Costa, director of health policy at Netcare.

“Netcare is prepared to take any of the third parties’ submissions into account and intends to do so during the inquiry process.”

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