The Hospital Association of South Africa (HASA) notes with concern that the OECD-WHO study that claims private hospital costs in South Africa are expensive continues to be presented publicly as fact, despite the many criticisms the study has received and that the study group has evidently not responded to, from independent actuaries, funders and hospitals alike.

The OECD-WHO study and its conclusions were recently presented at the Board of Healthcare Funders (BHF) conference in Cape Town.

It is HASA’s view that the OECD study essentially measures affordability of private hospitals in a society that suffers among the highest Gini coefficiencies in the world, and in which the vast majority of households regrettably receive very low incomes. In such a society, most goods and services can be considered expensive.

Moreover, the study compares South African private hospital prices with a basket of OECD country’s public health systems but fails to note that public sector prices in some of these countries are insufficient to cover costs and that these public health systems are therefore running at deficits. It HASA’s understanding that the OECD did not adjust for public health budget deficits.

As further examples of the many concerns raised about the study, it fails to discuss the socio-economic status of the private hospital sector and existence of a large public sector in which hospitals provide subsidised services to a majority of the population. Nor has the influence of the exchange rate on hospital input costs been adequately provided for and this, by the OECD-WHO study group’s own admission, is a severe limitation in the study. Further, the OECD-WHO paper provides an ill-advised comparison of overseas national population-based healthcare systems with a voluntary private healthcare system.

HASA note also that the healthcare market inquiry questioned the use of Consumer Price Index (CPI) as a baseline to measure affordability of healthcare services. It has long been HASA’s contention that a more appropriate measure should be used to measure healthcare inflation.

Finally, had the OECD study measured affordability of private hospitals among the markets they serve, it would have found affordability of private hospitals in this country would compare favourably to  OECD countries. Yet this fact is hidden in the study and the presentation made by the OECD.

It is HASA’s opinion that the report and the presentation made at the above-mentioned conference reflect a significant bias from the OECD that does not serve to advance the current healthcare debate, nor does its refusal to share the study’s data.

As South Africa wrestles to correct a struggling healthcare system, informed and stringent researched opinions and viewpoints are always welcome. The healthcare debate though, is not well served by research that is questionable and could result in misperceptions. HASA would suggest that the OECD-WHO work group successfully addresses the many concerns regarding its report before presenting it again in public.

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