The Portfolio Committee on Health met to discuss the findings of the Competition Commission’s Health Market Inquiry (HMI) Report, which investigates the state of competition in the South African healthcare sector.

The HMI was initiated in 2013 to assess features that may impede affordable healthcare access and its final report was published in September 2019.

Responding to the commission’s presentation, the committee focused on various concerns with the National Health Insurance (NHI) and the implications for the healthcare system, particularly in light of the HMI’s recommendations.

Committee members asked about the origins of current challenges in the healthcare sector, emphasising that many issues stem from historical changes to medical schemes made before the current administration. During the engagement, it was noted that the previous regulatory environment, which guaranteed payment to providers and uniformity in care, has eroded, leading to confusion and instability. Members made a strong call for a return to foundational principles, including statutory tariffs and guaranteed benefits for medical scheme members, to restore order and fairness in the healthcare system.

The economic implications of the NHI were also highlighted. The committee expressed its concern that the transition could exacerbate existing issues within the healthcare sector. Committee members also called for a thorough investigation into potential collusion among major market players and highlighted the importance of ensuring that the NHI implementation does not lead to further monopolisation of healthcare services.

The committee’s discussion also focused on potential challenges in implementing the NHI within the current fragmented healthcare environment. Concerns were expressed that without a coherent regulatory framework, the goals of the NHI may be undermined. Members raised questions about how the government plans to engage with existing healthcare providers and stakeholders to incorporate their perspectives into the NHI rollout.

The need for collaboration between the ministries of Health and of Trade and Industry was another issue mentioned as crucial for creating a unified approach to healthcare reform. The committee indicated that such collaboration is essential for addressing both health outcomes and economic impacts, allowing for the development of policies that promote innovation and competition in the healthcare sector.

The role of the private sector within the NHI framework was also discussed, focusing on balancing contributions from private healthcare providers while maintaining a robust public healthcare system. The committee emphasised the necessity of feedback from both the public and private health sectors to create a fair and efficient healthcare system.

Making his contribution on the report, committee Chairperson Dr Sibongiseni Dhlomo, expressed deep concern regarding maternal healthcare outcomes in South Africa, particularly the stark differences in delivery methods between public and private hospitals. He noted that in public hospitals, approximately one million babies are delivered annually, with only three out of 10 mothers opting for caesarean sections. In contrast, in private hospitals seven out of 10 women delivering via caesarean, raising issues about the motivations behind these choices. Dr Dhlomo emphasised the importance of natural deliveries, highlighting that women are capable of delivering safely without unnecessary surgical interventions.

He criticised the practice of prolonging hospital stays for women who have undergone caesarean sections, pointing out that many are required to remain in the hospital for several days post-delivery, which incurs additional costs and may not be medically justified. He argued that the standard of care should allow for early discharge, particularly for women who meet health criteria within six hours after delivery. Dr Dhlomo called for a revaluation of these practices, advocating for a healthcare system that prioritises the well-being and autonomy of mothers, rather than financial gain.

He urged the Department of Health to respond proactively to these concerns, emphasising the need for systemic changes that support equitable and high-quality maternal care across both public and private sectors.

In his concluding remarks, Dr Dhlomo asked the Department of Health to take note of all the questions and concerns raised during the discussions. He said the department would be given the opportunity to respond in detail when the committee convenes for its next meeting. “This approach ensures that the Department of Health can provide comprehensive answers and engage in meaningful dialogue regarding the issues surrounding the National Health Insurance and the findings of the Health Market Inquiry Report,” said Dr Dhlomo.