Johannesburg — THE Council for Medical Schemes releases its report on medical scheme cost increases this week.

It puts most of the blame on private hospitals. It's a substantial report and, really, you enter the debate about who is to blame for rising medical scheme costs in SA at your peril. The area is fabulously complex and even the statistics are highly debatable. The very basis for the council's conclusions have been questioned by the industry.

Intuitively, I suspect the council's argument that the market has become more concentrated and that this is partly to blame for rising prices is correct. But equally intuitively, I suspect that their argument in favour of what they describe as "central bargaining" would be disastrous. Essentially they appear to be are arguing not for "central bargaining" as such, but for set tariffs.

If it's true that the total number of people covered by medical schemes has been steadily reducing, then the council is no doubt correct in being concerned about this trend.

But it also describes the situation in which three groups, plus independents all of roughly the same size, compete as an "oligopoly", which is stretching a point. Lots of other industries in SA have far fewer players.

You could look at it another way, and track the margins of the hospital groups. The largest of the private groups, Medi-Clinic, suggests the trend is worrying but not heart-stopping. Medi-Clinic's margins are high but in fact their latest results see margins actually contracting. Some better, less shrill, less vituperative, and more open discussions should be brought to a problem that confounds the best brains in the world.