The Private Medical Sector

The private health sector is not a highly profitable sector, contrary to the general belief. Private clinics are fighting to survive in the face of growing expenses and rely on the goodwill of government which offers a free medical service.

The Republic of Mauritius, with a population of 1,261,447(2014) can boost of a high level of Health Care Delivery in this part of the world. Government offers a free medical service to the whole population, including consultations, in-patients treatment, surgical and gynaecological interventions, investigations, free drug supply, without forgetting school health, vaccination, antenatal care and health education.

The Private Medical Sector forms a complementary service to that offered by the State. This comprises private pharmacies, medical supplies and disposables, medical consultations, dental and optical health care, private laboratories, imaging diagnostics, glasses and hearing aids, and services provided by private health institutions (clinics).

In 2015, 27.2% of the population followed treatment from private health care institutions. At present, there are 17 private clinics with an availability of 647 beds. In addition, there are 20 private medical laboratories, 324 private pharmacies in the country. The private health sector employs around 2,000 employees, and 1,352 doctors, 308 dentists and 467 pharmacists are practising in this sector.

The private health institutions, functioning under the Private Health Institutions Act, are supervised by the Ministry of Health and Quality of Life. In 2015, 227,954 patients have been admitted in the private clinics, 24,565 patients have undergone surgery, and 3,270 ladies had their deliveries normally or by Caesarean section.

In 2014, the total out-of-pocket spending on health in the Republic of Mauritius was around 2.8% of the Gross Domestic Product (GDP). The per capita out-of-pocket spending on health was around Rs 8,568.54. Of the amount spent, almost 27.07% was on pharmaceutical products, 20.28% on medical supplies and disposables, 11.20% were fees paid to medical practitioners, and 8.58% went to the private clinics.

For the current financial year, the budget allocated to the Ministry of Health and Quality of Life is Rs 9.72 billion. The household's out-of-pocket expenditure in the island outsized the budget of the Health Ministry by almost 16.34%, i.e. Rs 10.71 billion. Most of the patients who have recourse to private health care providers do so at their own will or necessity. They attend the private clinics as they can choose the medical practitioners with whom they want to follow their treatment or for undergoing surgery, they can afford to do so financially and for the additional hotel-like facilities provided by these institutions. Out of the 27.2% of the population attending the private clinics are either insured or pay out of their pockets.

In 2015, 227,954 patients have been admitted in the private clinics, 24,565 patients have undergone surgery, and 3,270 ladies had their deliveries normally or by Caesarean section.

In 2014, there were around 15 private health insurance companies operating in the country, insuring about 185,000 lives. The total amount of premiums collected by them through individuals and corporate contribution was Rs 1.51 billion, compared to Rs 565.50 million in 2008/2009.

The Health Ministry closely supervises the private health care providers through regulations. In all countries, the public-private partnership improves health indicators thanks to a close collaboration. The legal and regulatory framework, and accountability rest with the authorities. Common mutual understanding and sharing of resources must be practised by both sectors. Less forgotten, the private health sector in Mauritius first introduced the CI-Scan services, and renal dialysis.Trust between both sectors will benefit each partner, for the well-being of the population at large, and this must be encouraged.

The private health insurers have joined hands and elaborated a scheme regulating the fees to be paid to the medical practitioners for their services, grading the services from 0 to 7. The sum to be paid to the private clinics is also determined as per the facilities offered. As for non-insured patients, they solicit the help of the doctors of their choice whom they trust, who finally guide them for the type of treatment to be followed, and the appropriate clinics to attend. The fees for the clinic will depend largely on the rates of the rooms, fees for investigations and medical treatment, and in case of operations, fees for the operating theatre. They can get an approximate idea of the bill from the clinic.

The quality of pharmaceutical products, as well as the profits on wholesale and retail sale, is controlled by the authorities. The national councils, through their respective acts, also control the services offered in the private health sector. With the poor/rich ratio dynamically changing, a shift in the philosophy of health care deliveries must be envisaged. The State cannot go on increasing the Health Ministry's budget year after year. A national health insurance program is equivalent to a compulsory saving for one's health. Anyway, in a welfare state, there is contribution from the population through taxation and other forms of government income. The government must encourage health care delivery by private sector to lessen its burden of over increasing spending. India is a very good example of this attitude, liberalizing the private sector through incentives and tax free periods, gearing up massive private care providers. Soft loans can be another encouragement.

Medical equipment are very expensive. The private health sector, unless backed by wealthy corporations, cannot afford to purchase these. The returns are limited as our market is a small one. Pet scans, equipment for radiotherapy, robotic surgery, organ transplants, and stem cells are some of the services to be developed. The government must be aware, and be concerned of the difficulties faced by the private sector. There is a lack of formed skilled workers in different fields. Patients, whether insured or non-insured, do not appreciate increase of prices by clinics. The private health sector is considered a highly profitable sector. If this was true, business people and corporates would have invested in this sector. On the contrary, the private clinics are fighting to survive. Year after year, the price of food items and vegetables, electricity and water, licence and trade fees, the salaries of employees through yearly compensations, go on increasing and adding the financial difficulties of the private clinics. Th salaries of employees have almost doubled in the last ten years.

The private health care providers contribute in the economy of the country. Insurance cover to civil servants, the national development programme through HRDC, and facilities for organ transplants are good signs. This sector relies on the goodwill of the government.

Dr Dawood OARIS, OSK

Source : Discover & Invest Issue 5