Hospitals, specialists drive up costs

2012-08-14 21:46

Johannesburg - The Board of Healthcare Funders of Southern Africa (BHF) has welcomed the health department's finding that hospitals and specialists are driving up medical costs.

Expenditure on private hospitals by medical schemes rose by 109.3% in real terms between 2000 and 2009, according to the Council for Medical Schemes' 2010 annual report.

"This equates to 37% of the approximately R84bn collected by medical schemes from their members," said the BHF in a statement.

"The refusal by hospital groups to provide data on the cost of providing hospital care to the BHF and others has meant that the only way of conducting studies on pricing is to obtain data from other countries for similar healthcare services," said BHF spokesperson Humphrey Zokufa.

The lack of transparency had also resulted in smaller medical schemes being charged higher hospital tariffs than bigger schemes.

Hospital groups formed an oligarchy and wielded market power.

Secondly, there were no set prices for healthcare services, allowing providers to charge at any rate they pleased.

The set of minimum benefits which medical schemes had to cover by law were mostly hospital- and specialist-based conditions.

A 2006 BHF analysis had shown that costs within JSE-listed hospital groups were consistently higher than those of independent hospitals.

However, no explanation had been offered for this discrepancy by hospitals.

"Hospital groups should not be defensive about these types of studies, but should rather be coming forward to explain as to how they will be making healthcare more affordable for the average medical scheme member," said Zokufa.

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  • UNITY - 2012-08-14 22:22

    Yes, the healthcare sector of professionals, are overcharging for their services. Its greed and no one cares if u fall on their doorstep without cash! I don't believe its not profitable to be in this sector,everyone in business needs to practice more smarter, than complain when your GP margins drop!many citizens of the country cannot afford medical aids, and more doctors and professionals are needed in the country to make a difference to the economy, then selfishly proclaim, that they will not make profit, which is lies!

      akaRags - 2012-08-14 23:00

      True. I have been working in a pvt hosp group for over 15 yrs, as a nurse, and I work just as hard as the drs and management but for a fraction of their salaries, - I watch them swan in and out, in their luxury vehicles, go on nice holidays to sunny islands, while I ride an old scooter to save money and go camping at the local dam, once in a while. Still, I know there are people who are worse off than me, and I count my blessings, but us plebs know that the pvt hosp groups make big profits.

      opinion.blake - 2012-08-15 11:56

      Iv'e got an idea. Why don't we just pay EVERYONE the same salary each month? That will be great won't it? Then those sitting by the security gate can enjoy the same wealth as the engineer designing the cutting edge new bridge or the surgeon delicately removing the brain tumour. Won't that solve everything? But wait! Why then would anyone study for 15 years and work 20hr shifts to become a surgeon if he could just sit outside the gate and earn the same salary? Your understanding of how the world and human nature works is astounding.

      goldwright - 2012-08-15 12:16

      @opinion.blake - I've actually just commented on what you said, as I said, I don't expect to be paid as much as a top specialist, but really, nurses don't get paid particularly well, we all know that, and then people wonder why the quality of nursing has dropped; because all the really good nurses go to Saudi or move overseas to make a decent living and youngsters who may think of going nursing, would rather go into other jobs where they know they are going to make more money. It's not about us ALL getting the SAME salaries, - it is more about the HUGE differences in levels of salaries.

      goldwright - 2012-08-15 12:29

      Not to mention the fact, that nurses also work long shifts, weekends, public holidays, nights and also work in theatre assisting surgeons, or look after critically ill patients in ICU, on ventilators etc, or look after prem babies that at times weigh close betwen 500g's - 1kg, or work in casualty where you never know if you are going to have a gunshot/stabbing/heart attack etc etc get pushed in, and you think the likes of me don't have a right to question our salaries?

      opinion.blake - 2012-08-15 12:46

      @akaRags: You're right. You should be paid more.

  • opinion.blake - 2012-08-14 22:33

    You can't trust the Health Department to provide Panado to a local clinic but you should trust them for an accurate economic analysis of private healthcare cost? Yeah right!

  • phae.rayden - 2012-08-14 22:43

    Always wondered how Doctors manage to tie this kind of robbery and arrogance in with the spirit of the hippocratic oath in today's society that cannot survive without money.

      opinion.blake - 2012-08-15 11:13

      Arrogance and robbery? Please substantiate or rather leave the commentary for the informed.

      opinion.blake - 2012-08-15 12:12

      The spirit of the hippocratic oath does not imply working for free or at a loss. Very few SA doctors still recite the hippocratic oath if any. It's an oath sworn to various so-called gods and other medievel beliefs. It's outdated.

  • lacrimose.wolf - 2012-08-14 22:54

    Govt's own law in 2003 stopped the min-max scales. These regs the health care industry set up until then, were declared as against competition laws. So they opened up one of the gems of ZA society - health care - to bandits and kings. If you heard SAfm debate today, you would have learned that ANC is cornered on their schizophrenic ideas that they now have to manoeuvre their way out of. Without losing face. As usual, blaming the private sector for their rubbish policies, procedures, memorandums, and enough paper to fill a continent - but not a tooth.

  • juannepierre - 2012-08-15 05:23

    Private hospital... Shoddy doctor left my operation for 24hours, because he forgot the evening before. Then a nurse threatened me because I complained of pain. Then I had to pay the bill. But if I went to a public hospital I probably would have died on arrival. Moral of the story... Stay healthy in South Africa, very very healthy.

  • winifred.watson.9 - 2012-08-15 07:15

    I know it is a priviledge to have pvt health care today mainly because govt medical care is absolutely disgusting. I really feel sorry for those people who have no other option. Needless to say, the people who are really getting hammered is the members who belong to medical aids. My husband had a small op earlier this year. Our medical aid paid the hospital in full and mainly because it was their recommended hospital. The specialists etc got paid at 200% of medical aid rates which worked out that in the end we were out of pocket to the tune of R15 thousand rand. We are pensioners, our income has been reduced to nearly nothing by govt dropping the interests rate. Already our medical subscription takes up just over half of our income. We are too afraid to drop our medical aid and have vowed to battle it out to the last. What I am really trying to say, is that Medical aids wont pay out more that they have to and now Doctors etc can charge what they like, so that puts us who are paying for these services in the middle. We are the ones that are being ripped off. Its time medical aids, govt and doctors etc thrashed this out. Medical aids are always complaining they are being hit hard, they only pay according the rates set down by the Medical association.

  • winifred.watson.9 - 2012-08-15 07:32

    There needs to be some regulator and if doctors want increases then this needs to be address, at the same time Medical Aids will have to start giving some value back to their clients. Who suffers the most, the people who are caught in the middle.

  • john.markham.737 - 2012-08-15 07:42

    Now these people are worse than the ANC. The ANC steel from the poor but these people steel from the sick and the dying. They will keep you alive till they've got your last cent. They will then tell the family there is no hope and suggest that the machines must be switched off. Sickfunds are the same. Then the undertakers move in....

  • arm.witmens - 2012-08-15 07:43

    All they will do is charge you double the reccomended rate, the scheme will pay half and you will be stuck with a bill. Its happening now, so i dont know what the outcome of this report will wont help me with a doctor charging private fees.....

      opinion.blake - 2012-08-15 11:22

      You people just don't get it! What do you mean with the "recommended rate"? Who recommends it and how did they calculate the "recommendation"? That's the whole point! How can you accept your medical aid's "recommendation" about a fee as the standard to which the doctor must conform? Does your business work like that? Do you think Toyota is gonna sell their cars at the prices Nissan recommends?

      ismail.moola.52 - 2012-08-15 13:55

      I am with Blake on this one - Doctors are service sector people who bill per procedure - obviously they are going to charge what they want Doctors are also subject to far more regulation than either attorneys or accountants, and no one complains about their fees

  • imtiaz.osman.5 - 2012-08-15 07:47

    The problem is with the legislation they limit student that want to go into this field so the supply remains short and demand is high thus giving doctors the chance to overcharge

      opinion.blake - 2012-08-15 11:46

      So what are you saying? Should we just dish out medical degrees to everyone that can thread a needle? We're talking about cutting edge medical science here, not throwing dolosse.

  • gregory.martin.5070 - 2012-08-15 07:47

    "The refusal by hospital groups to provide data on the cost of providing hospital care to the BHF and others has meant that the only way of conducting studies on pricing is to obtain data from other countries for similar healthcare services," said BHF spokesperson Humphrey Zokufa. This statement on its own tells one how crooked they are.Why do they not want to provide the info?Health Care professionals,particularly in private hospitals,are extremely arrogant and think they are gods.They rip sick people off, even poor old struggling pensioners,so that they can live very extravagant lives.They are disgusting, the vast majority of them.

      ismail.moola.52 - 2012-08-15 13:56

      Why would you want to give as a business the oppososition your competitive trade secrets away. I have a theory - if you gave the private sector the money the state sector pays out - you would get better care for patients

  • annaline - 2012-08-15 08:51

    I aggree..was in hospital recently for a routine operation, woke up a few days later in ICU...the costs are astronomical, it seems that every doctor in the hospital came round to "visit" me and charged rates that my medical aid is not prepared to cover...i did not request all these specialist to come and "see" me...some of them I have never heard of before... and now I am left with a R36000.00 "portion" that i somehow have to scrape together. I am being called every day by these doctors rooms to find out when payment will be made, the one keep on phoning for an amout of R11.11c for a test strip that the medical aid did not pay for...i am going to pay it off over 12 months (hahaha)

      albie.cilliers - 2012-08-15 10:03

      Annaline, I suggest you go over your medical bill with a very fine comb, line for line, and check the codes used to charge you. Often wrong codes are used to inflate charges, unneccassary visits added, etc, etc. Also these admin personel of these doctors are very arrogant when you dare question your bill, but "Byt vas" and stand on your rights !

  • opinion.blake - 2012-08-15 11:43

    If people would just equally maon about the prices of DSTV, locksmiths, soft toilet paper, Woolworths, Mango flights and Klipdrift. Get over it, to practice medicine or do good surgery is a scarce skill that will become more so in future. Skarce skills costs money. The more government put unfair pressure on private health the less doctors and hospitals will be willing to do business in SA. These bully tactics by goverment will in the long run just massively increase the cost of healthcare. Why? Because no one will be willing to work here as doctors anymore. Can do MUCH better overseas. If you are disgruntled with private health don't kill it, just rather go to the public facilities. If private health is'nt allowed to be run as succesful businesses it will vanish over time and what you'll be left with is the local understaffed and understocked government clinic...midievel medicine here we go!

      goldwright - 2012-08-15 12:06

      I understand what you are saying - scarce skills, as you say, cost. By the same token though, nurses are scarce skills too and yet we get paid a fraction of what Dr's and management do, and we also work hard. I'm not saying I expect to get paid as much as a neurologist, peadiatrician, specialist surgeon etc, but c'mon, there is something not quite right........ Yes, private health care should be allowed to be run as succesful businesses, but to a degree - there are some unscrupulous/questionable charging tatctics around which shouldn't happen. However, private hosp groups and private doctors are still in the "business" of dealing with human lives and it shouldn't be all about making big profits.

      opinion.blake - 2012-08-15 12:18

      You're right. It should'nt all be about money, and it is'nt.

      opinion.blake - 2012-08-15 12:31

      You're right. It should'nt all be about money, and it is'nt. The essence is that Medi Clinic, Life Health, Netcare or your local private doctor will not be here at all if they weren't in a position to sell their service/skill at a profit. Then there would be NO hospital or doctor to moan about. That's the way the cookie crumbles. We are so fixed on regulating the service provider of 10% of the population that we conveniantly forget to fix the shambles the system is that's suppose to provide for the 90%. About scarce skills: I'm sure they'll be willing to pay you just as much as the doctors if your'e willing to take on the burden of personal full responsibility for the surgeries and treatment plans of your patients.

  • - 2012-08-15 12:32

    This is just great! Now let's get some tariff guidelines for lawyers, CAs, plumbers and goodness knows what else as well. It always amazes me that people are quick to throw a tantrum about a doctor's consultation fee, but wouldn't think twice to pay R780 to fill up their car or pay R400 for a bag of groceries. But nevermind the 12 years I had to spend to BECOME a specialist - medicine is charity-work and surely it would be complete wrong to earn money for doing my job properly. If the HPCSA started working WITH us and stopped just worrying about protecting the public, we could probably have a better system, but no...

      st.oculus - 2012-08-15 13:37

      All those who complain so vociferously, your wish will be granted when NH is implemented. Pity you won't see any properly trained doctors left in the RSA...

      ismail.moola.52 - 2012-08-15 13:58

      I am with you Bernard - the public dont seem to understand that health is a commodity and damn we worked hard to get our degrees. And why the focus on doctors - have you seen what Senior Counsel or CA's charge

      annaline - 2012-08-15 14:42

      Just need to mention that I was once married to a medical practitioner...and there is a difference between decent charges and overcharging...most doctors in RSA does not charge the BHF rates but choose to charge way above...and the medical practitioners I dealt with are not living below the bread line..and overcharging has nothing to do with NH to be implemented ...enough said

  • ismail.moola.52 - 2012-08-15 13:50

    Health care is a business. A very big one.Due to failure of universities to train more doctors, due to the problems with training posts, due to the emigration of skilled specialists we actually have an extremely small pool of specialists in the country. If you look at sub-specialists (ie specialists with a further 2-3 years training in their discipline) the numbers are even smaller For example : No of Subspecialists: 1) Pulmonologists - 60 2) Gastroeneterologists - 60 3) Cardiologists - 150 4) Rheumatologists - 55 The list goes on and on And here is the crux, in a resource constrained economy the person with the skills prospers. To become a specialist is a 12 year process, To be a subspecialist 15 years. Specialist will charge what the consumer or medical aid will pay - If you dont like what they charge, find another doctor - it just may take a bit of time for an appointment

  • tereza.correia.921 - 2012-08-15 15:09

    In response to the claim of non-transparency by the BHF, Dr Roly Buys, Executive I Funder Relations & Contracting at Mediclinic, says hospital groups do not refuse to provide data on the cost of care - the BHF represent the schemes, who have all of the claims data, hence the information is freely available to conduct proper research. That there are currently ‘no set prices to be charged for healthcare services therefore allowing healthcare providers to charge at any rate they please’is untrue says Dr Buys, as Mediclinic contract prices, and do not bill more than the contract. Outcomes are also published in their annual report. With regard to ‘analysis being conducted by the BHF and presented at the 2006 BHF conference showing that the costs within the JSE listed hospital groups was consistently higher than those of the independent hospitals’, Dr Buys says Mediclinic would like to see the comparison, and the methodology behind this claim, as international experts from a number of universities have come to the conclusion, and published papers at the European Health Economists conference, that “NO-ONE KNOWS THE TRUE COST OF TREATMENT”

  • cameron.macfarlane.12 - 2012-08-15 17:45

    Unfortunately it seems a medical degree is worthless to practitioners without an expensive German car, a stay at home wife and a Tuscan Villa. It boils down to a sense of entitlement.

  • asif.laher.10 - 2012-08-16 06:15

    It takes 12 to 15 years to become a medical specialist. These guys work their socks off. Long hours away from their families etc, earning little during theit training, and paying off their student and home loans. They finish studying at agee 33 usually ( if they started at age 18). They are a priceless commodity, and easily mobile. Can go anywhere in the world and work. They are scarce as hell, and to get an appointment with the best can easily take 6 months. The public will EASILY pay a hairdresser or a beautician or a massage parlour a grand without batting an eyelid. Health is a grudge purchase. People that do your nails train for 3 months, people that nail your femur when it breaks at age 70 train for 15 years. My advice: Stop smoking, Stop Alcohol, lose weight, exercise and stay as healthy as possible. The same guy that complains about the 5k his cardiologist just charged him to save his life, easily smokes away 1.5k a month to buy his ciggarettes.

      goldwright - 2012-08-16 21:26

      I am a nurse with 20 years experience, the last 10 in neonatal ICU, (a highly specialized area of nursing with tiny prems & ill newborns). I also work long hours & work my socks off yet get paid but a fraction of these specialists; don't get me wrong here, I'm not saying I expect to get the same salary as a specialist, but the pvt (& gvt) hospitals CAN do better for their nurses, who are also easily mobile, with the right qualifications. I was shattered some years ago to find out that a receptionist in the dental (day) unit, of the same hospital group I work at, 10 years younger than me,(in her early 20's)was earning the SAME as me - no nursing qualifications - she'd been to tech for two years having done a "business" degree; she was working normal hours, with the occasional Sat morning time, compared to my nights, weekends, public holidays & overtime.Surely something is wrong with that sort of situation? No wonder young women (& men) would rather go into more highly paid jobs with their "business" certificates, than nursing. Of course specialists are highly qualified and have worked extremely hard to get where they are, and they have my respect for that, but how can people say that private healthcare is a business, & these Dr's need to get paid top dollar, when nurses are just expected to be Florence Nightingales, not complain & get on with it. This is not just about loosing Doctors, this country has already lost MANY really good nurses, because of bad political leadership.

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