‘Medical scheme trustees would be negligent in their duties if they did not go to all hospital groups in search of the best value for their scheme members,’ says Otto Wypkema, CEO of the National Hospital Network.
The National Hospital Network is a group of 74 independent private hospitals, day clinics and psychiatric clinics and ophthalmic clinics and is the fourth largest private hospital group. The group has a comprehensive footprint with solid representation in South Africa’s major cities and represents almost 18% of the private sector beds.
Historically the group has positioned itself as an affordable provider of medical care. Industry bodies such as the Council for Medical Schemes and the Board of Healthcare Funders have acknowledged the price efficiency of the National Hospital Network in the past.
‘In the current price sensitive environment we at NHN have been surprised at how few trustees of medical schemes have requested briefings on our price structure,’ said Wypkema.
‘We are also surprised that not more of the medical schemes require their members to make better use of Day Clinics, which are appropriate and certainly more cost effective for certain procedures.
‘A number of procedures are routinely performed at day clinics. Dental procedures include extractions, crown and bridge work, periodontal surgery and implants. Gynecological procedures include sterilization, D&C, biopsies and examination general anesthetic. Ear, nose and throat procedures include tonsillectomies, adenoidectomies, sinus cleansing and the insertion of grommets. Orthopedic procedures include the correction of digital abnormalities, examination and exploration of joints, shoulder and knee arthroscopy, tendon and muscle surgery and the manipulation of fractures,’ he said.
‘Our hospitals favour the fee for service pricing model, as it is transparent and places the doctor at the center of the treatment process. Volume-based designated service provider contracts (where medical schemes contract exclusively with certain hospital groups) are not necessarily in the best interests of patients as they sometimes require patients and their families to pay for transport costs, adding to out of pocket expenses,’ he said.
‘Proposed government regulation of hospital procedures would not be in the interests of our hospital group as they would remove our present competitive edge,’ said Wypkema.