How healthcare patients pay the price for anti-competitive conduct

Accessibility and affordability of healthcare costs remain at the centre of local and global conversations aimed at reducing the cost of living.

Launched at this year’s Annual Competition Law, Economics and Policy Conference, the Competition Commission’s latest Cost of Living Report shows that electricity, water, petrol, transport, healthcare and communication costs are placing an increasing burden on consumers, particularly low-income households. These indicators continue to paint a bleak picture of the cost of living in SA.

While navigating these economic challenges, we often do not have time to think about how the businesses and services we use operate.

Speaking from personal experience, when I need an X-ray, I do not usually think about who services or maintains the machine. I may only notice when the machine is not working and I cannot get the healthcare I need.

This is particularly true in the public healthcare centres. South Africa’s competition regulator, however, has been monitoring the market conduct in the digital medical imaging (DMI) equipment space.

We took a closer look at the aftermarket of systems such as X-ray machines and ultrasounds. The commission is especially concerned if there is market concentration that might be driving up costs or restricting participation in this particular market.

Our intervention was occasioned by allegations of anti-competitive conduct in the servicing, repair and maintenance of diagnostic medical imaging equipment.

This market sector is important to the commission because DMI equipment enables SA’s healthcare practitioners to see inside the body, detect and monitor diseases, make accurate diagnoses, plan appropriate treatment and, in some cases, prevent disease. When this equipment is unavailable, delays in diagnosis can postpone treatment and worsen patient outcomes.

The impact is especially severe in public and rural facilities, where prolonged downtime and limited access to service providers may leave hospitals unable to diagnose and treat patients timeously. Because DMI systems cost millions of rand and typically remain in service for 10 to 15 years, timely access to software updates, spare parts, preventive maintenance and repairs is essential to extend their operational life, contain healthcare costs and maintain continuity of care. That’s why the commission recently referred four DMI equipment suppliers to the competition tribunal for prosecution over allegations of anti-competitive conduct in the servicing, repair and maintenance of DMI equipment.

What exactly does this mean? Our investigation is a pursuit of four firms that restricted independent clinical engineers’ access to the spare parts, diagnostic software, service keys, technical information and specialised training required to compete effectively with them in the DMI servicing, repair and maintenance aftermarket.

When market participation is limited like this, it may increase maintenance costs, reduce service availability for patients, and ultimately drive up healthcare costs. The bigger picture is that anti-competitive conduct in this sector has a direct bearing on diagnosis, treatment and patient outcomes.

The tribunal will now decide if the four firms’ conduct contravened the Competition Act (89 of 1998) as amended and, if so, impose appropriate remedies that will address the competition concerns raised, and hopefully give independent engineers better access to servicing, maintaining and repairing this crucial life-saving equipment.

• Makunga is spokesperson for the Competition Commission of SA

Sowetan