Public-private collaboration the way forward

In a frank exchange of views at the annual Discovery Health Industry round table event, experts from both public and private healthcare agreed that greater collaboration is required between the two sectors.

Kicking off the roundtable session, Discovery Health’s chief executive Dr Jonathan Broomberg said one of the trends dramatically impacting on both government and businesses working in the health sector is that patients and society in general demands much more than it did 15 years ago, or even as little as five years ago. Several important issues were raised at the conference:

Sharing of data

One of the many recommendations that have been put forward for the Inquiry into Private Healthcare Costs, is the recommendation for an independent coding system authority that sits with both medical schemes and private healthcare groups to develop a uniform coding system. Dr Ryan Noach, the deputy chief executive of Discovery Health, said there should be a broad-based adoption of health records that are accessible to all healthcare practitioners in the country, regardless of whether they are practicing in the public or private sector. Noach pointed out that since the introduction of Discovery’s HealthID app, the medical scheme now has hundreds of anecdotal incidents on record where healthcare providers are picking up aspects from the patient’s history record that are proving critical to their diagnosis. Dr Christopher Archer, the chief executive of the South African Private Practice Forum, agreed. “There is definitely a future in electronic patient record systems but there must be a single platform. With technology increasing at an exponential rate, such a system should be within the ambit of affordability and achievability in the near future,” he said.

Rising healthcare costs

According to Stats SA, healthcare is the fourth largest cost in household budgets, after food, housing and transport. “Besides healthcare being such a huge percentage of costs in households, part of the problem is that if you look at medical schemes, 80% of members are paying in more than they claim while 20% claim more than the surplus amount. The result is that only one out of every five members perceives value while one in every four members feels hard done by,” Broomberg said.

This perception is not helped by the fact that as technology has improved, new drugs are becoming available at huge cost. Dr Broomberg points out that just five years ago, the most expensive claims related to conditions such as leukemia and stem cell transplants. However, new drugs are increasingly coming onto the market at higher and higher costs. To illustrate, in the last year, two new drugs became available in the South African market. Sovaldi, a treatment for Hepatitis C, costs R1 million for a 12-week course, which works out to R12 000 a pill. Another new oncology drug, Servoy, costs between R1.5 million and R2 million per course. “If enough drugs of this kind arrive in our market, it will become more and more unsustainable for medical schemes to afford these new treatments. On the other hand, neither is it sustainable for medical schemes to simply say no,” he said. Broomberg says pharmaceutical companies and medical schemes need to find a way to share the risk so that these products can be funded in a sustainable manner.

Scarce skills

Another issue of increasing concern for both the public and private healthcare sector is the fact that specialist doctors are in scarce supply. According to Dr Vincent Maphai, the chairperson of the Discovery Foundation, there are only 5.5 specialists per 10 000 patients. "It gets worse if you run statistics in rural areas. Then you are looking at 5.5 specialists per 100 000 patients," he said. Dr Archer suggested that the structure of private practices should change. "The solo private practice is outdated and inefficient. We should be taking a leaf out of the book of other professionals such as lawyers and accountants and adopting a system of large group practices," he says. Archer said this would have significant benefits in terms of improved quality of service and a more efficient use of resources. He went on to suggest that in a group practice structure, specialists could be made available to provide services to the state.