Picture: THINKSTOCK
Picture: THINKSTOCK

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THE Health Market Inquiry, which has been bogged down by delays, has finally begun, with the onerous prescribed minimum benefits (PMBs) issue the first order of business.

The Competition Commission began the first day of public hearings into the country’s private health market, in Pretoria on Tuesday.

The hearings are two years late following concerns regarding the competitive nature of the private healthcare market.

The first person to give an oral submission during the hearing was stay-at-home mom Angela Drescher.

Ms Drescher said she was a member of Discovery Health Medical Scheme but she did not know about PMBs until last year. PMBs comprise a set of defined benefits, which ensure all medical scheme members have access to certain minimum health services, regardless of the benefit option they choose.

"There are 270 PMBs that are listed in 343 pages of thousands of diagnostic codes, written in medical jargon and terminology that few consumers can understand," said Ms Drescher.

She said members often ended up paying out of pocket, and medical schemes were supposed to pay them in full but that members were not properly informed about this.

Ms Drescher said her son suffered from clinical depression and her husband had hyponatraemia, a life-threatening condition where the level of sodium in the blood is abnormally low.

Both of the conditions are PMBs but Discovery told her that it did not cover them, she said. Only after her husband threatened to stop taking his medication, which would have landed him in hospital, did Discovery pay.

Ms Drescher said she was able to do something about the situation only because she had knowledge and access to information, unlike many South Africans.

She described her interactions with Discovery as difficult: "I never once felt like I was empowered."

The investigation into the private healthcare sector began in 2014 and the hearings are the last part of the process.

Judge Sandile Ngcobo, chairman of the panel appointed to conduct the inquiry, said at the time: "The purpose of this inquiry is to determine whether the process of competition in the sector is working well or whether it can be improved."

He said the Health Market Inquiry received 68 submissions from stakeholders in the sector.

"The number of submissions raises concern about the lack of information available to patients highlighting the general lack of transparency in accessing private healthcare information," said Justice Ngcobo.