Advances in medical technology tend to add to the costs of health care, but there are ways to keep the increases in check.
Medical schemes are braced for a slew of new technologies from blockbuster drugs to minimally invasive surgery, advanced imaging techniques and biotechnology breakthroughs.
"The latest drugs will bring big improvements in patients' quality of life but they will come at a high price," says Discovery Health principal officer Shaun Matisonn.
Until now, medical schemes have had the choice of paying the exorbitant prices of new drugs and devices or denying their members the latest medical advances.
Discovery is trying to find the middle ground. In an industry first, it has used its bulk purchasing power to get a pharmaceutical manufacturer to lower the price of a new medical device so that its cost equals its benefit to the scheme.
Johnson & Johnson (J&J) has agreed to reduce the price of its new sirolimus stent by 23% (from R22 000 to R17 000) for Discovery members rather than have the scheme boycott its technology. The scheme represents 1,45m people.
A stent is inserted inside an artery of the heart and inflated to hold it open to prevent clogging. Matisonn says that in about one in every eight cases, the stent becomes congested and further surgery is required.
J&J's new sirolimus stent is coated with a drug to prevent further clogging, thereby saving every eighth patient from further surgery. With each operation costing about R40 000 (excluding the stent), Discovery has calculated that for the new stent to be cost-effective, it should cost R14 000 or less - not R22 000.
Medscheme, which represents about 2m lives, has taken a slightly different but no less effective approach by creating a medicine price list (MPL).
Published last May, the MPL sets out the generic drugs it will pay for and how much it is prepared to pay.
Patients are required to pay the difference between the prescribed drug and the listed generic.
As a result, doctors have changed their prescribing patterns and patients have switched to cheaper generic drugs .
Medscheme director Gary Taylor says that from May to October 2002, the MPL forced medicine expenditure down by R22/member/month on participating schemes, compared with a R12 increase in nonparticipating schemes.
By the last quarter of 2002, 780 medicines (about half of all MPL-eligible products) had come down in price by an average of R46 each.
