​Dr Lungiswa Nkonki was appointed as a panellist for the Competition Commission of South Africa's Private Healthcare Market Inquiry in 2014, and welcomed the opportunity with open arms.

Nkonki – a senior lecturer in the Department of Global Health – had, for years, had a strong interest in public health and had been highly aware of the inequalities in access to health care in South Africa.

Nkonki, who teaches Economic Evaluation in Healthcare to post-graduate students, was part of the five-person panel chaired by former Chief Justice Sandile Ngcobo to investigate the state of competition in the private healthcare market. The Inquiry published its final report on 30 September this year.

The six-year process involved considering written reports and feedback from more than 175 stakeholders including hospital and doctor groups and medical aid schemes as well as public hearings.

Explaining why she embraced participating in the inquiry, Nkonki said: “The inequalities in healthcare really affect the health outcomes people have to live with. I have, for a long time, had a great desire to contribute in some way to the reduction of inequality in health outcomes in South Africa.

“Ideally, competition should translate into lower costs and more value for money for consumers. The private sector only caters for about 8.8 million South Africans – and there is a stark contrast between the private and public sectors in terms of health resources," she said.

Nkonki was born in Port Elizabeth and moved to the University of the Western Cape (UWC) in 1998 where she completed a degree in Medical Bioscience before doing a BSc Honours at UWC. She then did an internship with the Health Systems Trust, where her interest in public health was ignited. She then completed a Master's in Public Health at UCT focusing on Health Economics.

“While doing that I recognized that, because my previous training was not in economics, I needed more grounding in economics, so I went to the UK and did an MSc in Economics at the University of Sussex," she said. Nkonki then went on to get a PhD in Health Economics at the University of Bergen.

Explaining the background of the Health Market Inquiry (HMI) into the private healthcare market, she said the Competition Commission set it up “after observing that prices in the private healthcare sector were at levels which only a minority of South Africans can afford and that healthcare expenditure and prices were rising above headline inflation.

“The HMI is the first evidence-based process in South Africa that carefully gathered evidence and studied the private healthcare market. Our investigation included over 43 million individual patient records, 11 million admissions, specially commissioned studies, numerous written submission, public hearings and seminars.

“The inquiry focused its investigation on hospitals, doctors and funders. By funders we mean medical schemes who purchase healthcare on behalf of members and the administrators and managed care organisations that medical schemes contract with."

The HMI found that competition in private healthcare is not working as it should – and that private healthcare in South Africa is characterised by high and rising costs, significant overuse and no discernible improvements in health outcomes.

The inquiry identified a number of factors that contributed to these outcomes, including that three hospital groups – Netcare, Mediclinic and Life – dominate the market. “A few firms owning the majority of the market is an indication that competition may not be working effectively."

The inquiry also found that in South Africa there are no measures of quality in the public domain to know whether hospitals and doctors offer good or bad quality.

It also found that South Africa could save more than R2.7 billion (two percent of its current private healthcare spend) if it halved the number of people admitted to ICUs and improved the care for patients in wards.

A key finding is that medical scheme members often don't know what they are paying for and are not able to judge the quality of care they are getting.

The HMI made a number of recommendations which included implications for the planned National Health Insurance. The recommendations are aimed at creating greater competition, transparency and accountability on how medical scheme members' money is spent. In particular, they are aimed at increasing competition on the supply side (hospitals, doctors, and specialists).

Nkonki said it was an “incredible privilege" to be entrusted with the work of the inquiry. “It was a national study with important implications. We did our best to produce a product that is of value to South Africa today and in the future.

“A highlight for me was that the process, despite being robust and intense, was really consultative. The inquiry became a platform of real engagement."

“I'm pleased South Africa is embarking on this journey towards universal health coverage. I have a keen interested in the discussions on the NHI. The findings of the inquiry provide evidence that could be useful for the design of the NHI. The recommendations will, if implemented, be an incremental step towards creating an environment where the purchaser – the NHI Fund – will purchase from a private healthcare market that is competitive with lower costs and prices and more value for money for consumers. I'll be watching closely."

Caption: Dr Lungiswa Nkonki is a senior lecturer in the Department of Global Health and served on the Competition Commission of South Africa’s Private Healthcare Market Inquiry​

Photo credit: Wilma Stassen