It will not come as a surprise to learn that medicine is becoming increasingly expensive - and that is when you can get it. Some of the latest drugs on the market cost between R1.5-million and R2-million per patient, out of the grasp of most people and prohibitive for medical aids.Take the case of Yervoy, a new drug used to treat advanced malignant melanoma. On the first day it was available in South Africa, the country's biggest open medical scheme, Discovery, received five applications for treatment.story_article_left1Innovative drugs have meant huge advances in healthcare, but the hefty cost dilutes resources that might have been spent on more patients.Discovery Health CEO Jonathan Broomberg said numerous drugs at these prices were expected in the next few years, and this was not sustainable for schemes or funders.Locally, the medicine shortage has been compounded by how the government manages healthcare tenders.Aspen Pharmacare executive Stavros Nicolaou said: "This is particularly important when the rand weakens and imports become expensive and importers sometimes divert production capacity elsewhere."Local medicine manufacturers needed long-term contracts, rather than two-year cycles.Speaking at a recent round-table discussion hosted by Discovery, Nicolaou said there was a need to be smarter about how pharmaceutical goods and services were bought.Nicolaou said that when the government ran a tender for two years that was suddenly lost to another operator, manufacturers found work elsewhere. "Companies may move to something that is more sustainable and predictable [in terms of] plant volumes."Another challenge for the industry is life expectancy, which has increased from about 55 to 62 years, while economic growth has slowed to less than 2%.block_quotes_start We're living in a society where those using private healthcare incur costs six and a half times higher than those accessing the public system block_quotes_end"This means you have less to spend on social needs and an increasingly ageing population," said Nicolaou.This is bad news, considering that South Africa already spends 8.7% of GDP on healthcare - far more than the World Health Organisation recommendation of 5% of GDP.Healthcare operators say a single procurement process across the public and private sector would ensure greater affordability.Healthcare is the fourth-largest item in the average South African's household budget, at about 9%, and is rising every year.story_article_right2"We're living in a society where those using private healthcare incur costs six and a half times higher than those accessing the public system - and this creates social pressure for change," said Broomberg.Healthcare costs continue to increase disproportionately.Wages usually rise in line with the consumer price index, but medical scheme premiums increase three to four percentage points up above that.On average, 80% of medical scheme members pay more than they claim. The remaining 20% claim the entire surplus. This left four out of five scheme members feeling hard done by, said Broomberg. "It's different to using a cellphone or driving your car, or sending your kids to school, where you perceive value continuously."Professor Morgan Chetty, chairman of the Independent Practitioners Association Foundation, said: "If we want to change healthcare, our future conversations should steer away from how much we spend on healthcare to how well we spend it."..