The Hospital Association of South Africa (Hasa) welcomes the opportunity to respond to the article “Report exposes hospital rip-offs” by Jocelyn Newmarch (March 9).
Hasa, which represents 94% of all private hospitals in South Africa, is of the opinion that the headline is inaccurate and damaging.
While Hasa encourages debate about private hospital costs, it is not in a position to respond directly to the report published by the Council for Medical Schemes (CMS) and referred to in the article. To date, the private hospital industry has not had sight of this report.
Leading economist Mike Schussler was commissioned by Hasa to undertake independent research on private hospital costs. His research indicates findings that are contrary to those of the CMS. For this reason, we believe it is prudent that both Hasa and the council validate their respective findings so as to ensure accuracy, without which these conclusions could be needlessly damaging to the reputation of Hasa’s members. In particular, we believe that any accurate study is dependent upon conducting a thorough analysis of utilisation and cost factors in private hospitals.
The following considerations should also be taken into account when evaluating private hospital costs:
- The private hospital sector treats all categories of patients and is not restricted to the medical-scheme population alone. The most recent General Household survey indicates that a significant number of uninsured patients access healthcare services within the private sector. Any methodology applied to analyse costs needs to encompass all patients treated.
- With regard to emergency medical treatment, private hospitals treat a significant number of patients who are not insured, as the Constitution guarantees the right of all persons to such treatment at any health establishment. This is an unfunded mandate that hospitals are unable to plan for or quantify, subject to a number of uncontrolled variables. For example, if the total number of motor vehicles on South African roads increases by 7% per annum (as estimated), then the number of motor vehicle accidents will also increase. This, in turn, increases the number of trauma cases treated at private hospitals.
- Providing emergency medical treatment in cases where there is no cost recovery to the private hospital is a cost component that must be accounted for in any analysis of the sector. Late payments by medical schemes, other funds and non- payment by patients must also be factored into the equation.
- The medically insured population has stagnated, yet our research indicates an increase of 105% in the number of beneficiaries in the hospital sector. A significant component of any analysis of cost would therefore include utilisation.
- A thorough analysis of costs associated with salaries, including nursing costs and the increases experienced as a result of external pressures such as scarcity of skills, emigration and loss to foreign jurisdictions.
- The total number of patient days measured against real inflation.
Comparisons with other countries must be validated, the models utilised must be similar and the basket of goods being compared must be the same.
Hasa’s research will address some of these issues and will explore, in detail, how health services are accessed. Specifically, we will be looking at increases (if any) in maternity, medical and surgical cases. We will then analyse our data more aggressively to ascertain why certain trends have emerged.
Kurt Worrall-Clare is CEO of the Hospital Association of South Africa