Digital Healthcare Solutions (Pty) Ltd and Competition Commission / Healthbridge (Pty) Ltd (intervenor) (1) (41/AM/Jun02) [2004] ZACT 7 (4 February 2004)

62 Reportability
Competition Law

Brief Summary

Competition — Merger control — Notice of apparent breach — Digital Healthcare Solutions (Pty) Ltd challenged the validity of a notice issued by the Competition Commission regarding alleged breaches of merger conditions imposed in 2001 — The notice related to the integration of Practice Management Software with switching technology — Legal issue centered on the validity of the notice under the Competition Act — Tribunal held that the notice was validly issued and that the conditions imposed were necessary to mitigate competition concerns arising from the merger.

COMPETITION TRIBUNAL
REPUBLIC OF SOUTH AFRICA 
      Case no: 41/AM/Jun02
In the matter between:
Digital Healthcare Solutions (Pty) Ltd                  Applicant
and 
The Competition Commission                        1st Respondent
Healthbridge (Pty) Ltd                     2nd Respondent
(intervenor)
Reasons for decision
Introduction
1. This   case   concerns   the   consequences   of   a   putative   breach   of  
conditions   imposed   by   the   Competition   Commission   (“the  
Commission”) in respect of a merger approved by the Commission in  
2001, subject to those conditions, as a small merger. 
2. At issue is the validity of a notice of apparent breach (“the notice” or  
“the notice of apparent breach”) issued in regard to those conditions by  
the Commission on 28 May 2002 under rules 39 and 40 of the Rules  
for the Conduct of Proceedings in the Competition Commission (“the  
rules of the Commission”). 
3. The   recipient   of   the   notice   was   Digital   Healthcare  
Solutions   (Pty)   Ltd   (“DHS”),   which   is   the   applicant   in  
these proceedings. There are two respondents. The first  
is the Commission. The second is Healthbridge (Pty) Ltd  
(“HB”),   which   was   authorised   by   this   Tribunal   in   an

earlier application to intervene as a respondent. 1
4. The background is briefly as follows.
Background events
5. The merger in question took place in terms of an agreement concluded  
in   November   2000   when   a   company   then   named   Persetel   Q   Data  
Trading   (Pty)   Ltd   (“Persetel”)   sold   a   part   of   its   business,   known   as  
QEDI and conducted through a company named QEDI (Pty) Ltd, to a  
competitor,   Mediswitch   (Pty)   Ltd   (“Mediswitch”).   Persetel   has   since  
changed its name to Comparex Africa (“Comparex”).
6. The QEDI business was absorbed into that of Mediswitch, which has  
changed its name and is now known as Digital Healthcare Switch (Pty)  
Ltd (“DH  Switch”).  DH  Switch  is  a  wholly  owned  subsidiary of  DHS.  
Persetel received shares in DHS as the consideration for its sale of the  
QEDI business.
7. At   the   time   of   the   merger   Mediswitch   was   a   subsidiary   of   Bytes  
Technology   Group   Ltd   (“BTG”),   a   listed   company   once   known   as  
USKO, which is in turn a subsidiary of Allied Electronics Corporation  
Ltd (“Altron”). Altron is also a listed company.
8. Since   the   merger   DHS   has   been   owned   by   BTG   and  
Comparex. DHS is a holding company, which operates  
DH  Switch  alongside another  wholly  owned   subsidiary  
named Med­e­Mass (Pty) Ltd (“MM”). MM conducts the  
business   of   developing,   licensing   and   maintaining  
software   used   by   doctors   and   other   medical   service  
providers and known as practice management software  
or   practice   management   applications   (“PMAs").   PMAs  
help doctors and other suppliers of medical services to  
organise   their   business   operations   and   to   prepare  
medical   scheme   claims   for   onward   transmission. 2MM 
was   in   existence   and   in   operation   at   the   time   of   the  
merger.
9. The   business   of   DH   Switch   is   that   of   electronically   transferring   or  
1  Case no 41/AM/Jun02.

1  Case no 41/AM/Jun02.
2  Practice management software includes diaries, billing systems, patient records, debt collection,  
inventory management, financial accounting and reporting and creating interfaces with outside  
systems.
2

“switching”   information   about   patients’   claims   between,   on   the   one  
hand, doctors and other providers of medical services and, on the other  
hand, the administrators of medical schemes of which the patients are  
members. In this way the claims can be quickly processed and settled  
by the medical schemes, which are known in the industry as “funders”.  
Switching   of   information   in   this   manner   is   a   phenomenon   of   the  
computer   age,   supplanting   the   transmission   of   documents   and   the  
consequent paper­handling. 
10.To allow switching to take place between switch entities  
such as DHS and the PMAs used by doctors, a so­called  
interface,   known   in   the   industry   as   an   application  
programming interface (“API”), is necessary. The switch  
entities design and install APIs, for which they require  
access to the source code of the PMAs. 3In order to gain  
access,   a   contract   is   entered   into   between   the   switch  
entity requiring access and the entity owning the PMA  
software.   The   contract   covers,   inter   alia ,   the  
development cost and cost per site.  
11.Two forms of switching were debated in the case. The  
first   is   known   as   batching,   and   refers   to   the   habit   of  
some medical providers to wait till the end of a working  
day and then switch all their claims in a batch. This is an  
earlier  form  of  technology.  The second, a  more recent  
development,   is   real­time   switching,   by   which   medical  
providers switch every claim at the time when it arises  
rather than accumulating the claims for transmission in  
batched   fashion   at   the   end   of   a   day,   and   moreover  
receive an almost immediate response from the medical  
scheme’s   administrator.   The   two   forms   of   switching  
require   somewhat   different   versions   of   the   relevant  
technology. There are also hybrid versions of switching  
technology.4

technology. There are also hybrid versions of switching  
technology.4
12. Switching technology came about through the investment of relatively  
large sums in past years. Mediswitch and Persetel  were pioneers in  
this   technology   in   South   Africa   and   they   incurred   relatively   large  
3  Accessing, for instance, MM’s PMA software without an API developed or authorised by MM would  
constitute copyright infringement or software piratacy, also referred to in this industry as hacking.
4  A more detailed explanation of real­time and batched procedures is given in the affidavit of DHS;  
chief executive offider, Mr Du Plessis, at pp 178­179 of the record.  
3

investment expenditures of this kind.
13.Before the merger between QEDI and Mediswitch, QEDI  
controlled   approximately   95%   of   the   switching   market  
and   Mediswitch   3%. 5This   led   to   a   post   merger   market  
share of more than  95% in the switching market. At the  
same time,  Mediswitch  had a dominant market share of  
between 60% and 65% of the PMA market. 6The net effect  
of the merger was that DHS became a dominant player in  
the  switching   market   through  DH  Switch  as  well  as  in  
the PMA market through MM. 
14. HB is another switch entity. Two of its three main shareholders, each  
with   a   holding   of   some   29%,   are   large   administrators   of   medical  
schemes.   They   are   known   as   Medscheme   and   Discovery   Health.   A  
third   shareholder   with   a   similar   holding   is   Dimension   Data   Ltd  
(“Didata”), a supplier of information technology services. Medscheme  
and Discovery Health are the two biggest administrators in the market. 
15. HB does not supply PMA software.
16. It   is   a   characteristic   of   certain   contractual   arrangements   prevailing  
between HB and its shareholders, or some of them, that Medscheme  
and Discovery Health only permit HB, and not any other switch entity,  
to transmit claims made in real time to them. 
17. In   summary   therefore,   we   have   a   situation   where   post   merger   the  
dominant PMA vendor and the dominant switch provider reside in DHS.  
HB, its major rival in the switching market is not in the PMA market and  
has to enter into access agreements, so called front­end access, with  
PMA vendors to enter this market. On the other hand HB enjoys the  
advantage of real­time access with the two dominant medical scheme  
administrators,   Medscheme   and   Discovery,   who   collectively   hold  
approximately 60% of the equity in HB. This so­called back­end access  
is   only   possible   if   the   switch   provider   has   an   agreement   with   the

is   only   possible   if   the   switch   provider   has   an   agreement   with   the  
relevant medical scheme administrator.
18.The   merger   had   not   originally   been   notified   by   the  
parties to the Commission, but after its implementation  
the Commission required notification in terms of s. 13(3)  
5  See page 291 of the record at par 5.
6  Magennis, in his 22 September report on page 14, estimates MM’s market share of the PMA market  
at 60% while Genesis, on page 1055 of the record, estimates it to be 65%. 
4

of the Competition Act (“the Act”). 7
The   Commission’s   conditions   for   the   merger   and   reasons   for   its  
decision
19.Attached   to   the   Commission’s   merger   clearance  
certificate,   dated   9   April   2001,   were   the   following  
reasons and conditions: 8
“The proposed transaction raises significant competition problems. The  
parties involved are in the business of conveying claims electronically  
between   medical   practitioners   and   healthcare   funders.   The   parties’  
market shares, post­merger, for the electronic conveyance of claims  
for medical practitioners will be high. Furthermore, the merger raises  
vertical integration concerns, more fully discussed below.
In order for the Electronic Medical Claims Switching process to work,  
private   medical   practitioners   require   specific   Practice   Management  
Software (“PMS”) to be loaded on their computer systems as well as  
certain   functionality   to   be   built   into   their   systems,   in   the   form   of   an  
Application Program Interface (“API”). Med­e­Mass (Pty) Ltd (“Med­e­
Mass”), a subsidiary of Mediswitch controls a significant portion of the  
PMS market. Furthermore, Mediswitch is already vertically integrated  
and Mediswitch has allowed QEDI to interface with its PMS. 
All independent PMS systems are fully integrated with competitors in  
the  switching segment   that   require  the  transportation of  claims  from  
private   medical   practitioners   to   the   healthcare   funders.   The   PMS  
package   controlled   by   Mediswitch   group,   (Med­e­Mass),   is   only  
allowed to integrate with Mediswitch and QEDI. The vertical integration  
concern that the Commission has with this transaction is that there has  
been foreclosure by Mediswitch even prior to the proposed merger. If  
this is tied to the switching service rendered by QEDI, which will be  
acquired as a result of the proposed transaction, it is believed that the

acquired as a result of the proposed transaction, it is believed that the  
transaction will give rise to a substantial lessening of competition in the  
electronic claims switching market for private medical practitioners.
This will have a negative effect on the choice that the end consumer,  
which   in   this   particular   case   is   the   private   medical   practitioner,   will  
have with regard to the type of electronic switch he/she is allowed to  
interface.
7  In terms of the Competition Act a party to a small merger is not obliged to notify the Commission of  
the merger unless the Commission requires it to do so.
8  See page 26 of the record.
5

However,  the  Commission  is  of  the  view   that  the conditions  set   out  
below   would   significantly   reduce   those   concerns.   The   merger   is,  
therefore, approved, subject to the following conditions:
1. The merged entity shall, on reasonable written request by any  
healthcare   switch   entity,   integrate   the   applicable   latest  
versions of PMS packages which it owns or controls, with an  
API which enables an interface with the switching technology  
of the healthcare switch entity requesting such integration, in  
accordance   with   an   agreement   referred   to   in   paragraph   2  
below.
2. Pursuant   to   such   a   reasonable   written   request,   the   merged  
entity   shall   use   all   reasonable   endeavours   to   conclude   a  
written agreement with the requesting healthcare switch entity  
concerned,   within   a   period   of   60   days   after   receiving   such  
request,   containing   commercially,   financially   and   technically  
reasonable terms.
3. The   merged   entity   shall   provide   a   quarterly   report   to   the  
Commission,   for   a   period   of   12   months   after   the   date   of  
approval, detailing all requests by third party healthcare switch  
entities to integrate their  API  and  functionality with  the PMS  
packages owned or controlled by the merged entity, as well as  
detailing the agreements and time frames concluded with such  
third   party   healthcare   switch   entities   in   respect   of   the  
integration process.”
20. The meaning and interpretation of these conditions (“the conditions”)  
lay at the centre of the debate in this case. 
Relief sought by DHS
21. The prayers in DHS’ notice of motion, as amended in the course of the  
proceedings, are for orders as follows:
1. The Notice of Apparent Breach issued by the First Respondent  
against the Applicant dated 28 May 2002 be set aside.
2. It   is   declared   that   the   Applicant   and   its   subsidiaries   have

2. It   is   declared   that   the   Applicant   and   its   subsidiaries   have  
complied, alternatively substantially complied, with the merger  
conditions set out in the First Respondent’s merger clearance  
certificate dated 4 April 2001.
6

3. It   is   declared   that   the   Applicant   and   its   subsidiaries   are   not  
obliged to continue to negotiate and conclude an agreement  
with the Second Respondent for the integration of the latest  
versions   of   practice   management   software   packages   which  
they   own   or   control,   with   an   application   program   interface  
which enables an interface with the switching technology of the  
Second Respondent.
4. As an alternative to prayer number 3, it is declared that the  
merger   conditions   set   out   in   the   First   Respondent’s   merger  
clearance certificate dated 4 April 2001 be amended to include  
the   following   sentence   at   the   end   of   the   second   condition:  
‘including, without limitation, that such other healthcare switch  
entity   shall   cancel   any   agreement   which   it   may   have   with  
healthcare   funders   or   their   administrators,   relating   to   the  
exclusive   use   by   such   funders   or   administrators   of   the  
switching technology of such healthcare switch entity for the  
electronic   conveyance   of   claims,   whether   by   batch   or   real  
time.”
22. There was also a prayer for costs.
23. Prayer 4 was abandoned at a hearing on 21 November 2003 and no  
more will be said about it.
24. The amended notice of motion stated that the application was brought  
in terms of rule 39(2)(b) of the rules of the Commission, read with rule  
42   of   the   Rules   for   the   Conduct   of   Proceedings   in   the   Competition  
Tribunal (“the rules of the Tribunal”); alternatively the same rule 42 of  
the rules of the Tribunal, read with s. 27(1)(c) of the Act.
25. Voluminous   papers   were   filed   on   behalf   of   DHS   and   HB,   and   there  
were   also   substantial   affidavits   and   annexures   on   behalf   of   the  
Commission. Relevant passages will be referred to below. 
Preliminary observation on the issue of jurisdiction
26.In its papers DHS has raised two preliminary issues for

26.In its papers DHS has raised two preliminary issues for  
consideration.   These   are   that   the   notice   of   apparent  
breach   has   been   served   on   the   wrong   party   and  
secondly   and   alternatively   that   the   Commission   had  
failed   to   apply   its   mind   properly   to   the   question   of  
7

whether   there   had   been   a   breach   of   the   conditions  
before   issuing   the   notice   because   the   Commission  
entirely   misconceived   the   conditions.   It   was   agreed  
between all parties that these two issues could best be  
disposed of by being argued as points  in limine .
27. DHS had originally framed its application in terms of rule 39(2)(b) of the  
rules of the Commission. That rule states: 
Within  10   business  days  after  receiving   a  Notice  of   Apparent  
Breach, a firm referred to in sub­rule (1) may – 
(a) submit to the Commission a plan to remedy the breach;  
or
(b) request the Competition Tribunal to review the Notice of  
Apparent   Breach   on   the   grounds   that   the   firm   has  
substantially complied with its obligations with respect  
to the approval or conditional approval of the merger.
28. The   review   contemplated   by   rule   39(2)(b)   of   the   rules   of   the  
Commission is however not an untrammeled review having its roots in  
the common law but is confined to the enquiry whether there has been  
compliance with the terms on which the merger was approved by the  
Commission.
29. DHS   seems   to   appreciate   that   Rule   39(2)(b)   is   too   narrow   to  
encompass the points in limine that it seeks to raise. For this reason  
DHS amended its notice of motion, as we indicated above, so that it  
could rely on other procedural provisions to found this attack on the  
Commission’s notice of breach. Indeed counsel for DHS stated in their  
heads of argument, referring to the original notice of motion that had  
relied on rule 39(2)(b), that it was:
“  technically too narrow to permit of a decision on the  
two points in limine.” 9
30.Thus   what   DHS   has   sought   to   achieve   through   the  
amendment   is  to   found   jurisdiction   for   the  Tribunal   to  
entertain two points of law that relate to classic grounds  
of review in addition to the power we enjoy under rule

of review in addition to the power we enjoy under rule  
39(2)(b).   We   have   some   doubts   about   whether   it   has  
9  See Applicant’s Heads of argument, dated 13 October 2003, paragraph 2.
8

been able to achieve that. Nevertheless our jurisdiction  
to consider the points in limine has not been challenged  
by the two respondents.  10
31. For the purposes of this case we have assumed in DHS’ favour that we  
have  adequate   powers  of  review   to  hold  the  necessary   enquiry   and  
issue such an order. This should not be regarded as a precedent for  
other   cases   involving   comparable   claims   for   relief   going   beyond   the  
review contemplated in rule 39(2)(b) of the rules of the Commission.
The Commission’s notice of apparent breach
32.The   notice,   set   out   on   form   CC19   as   specified   in   the  
rules of the Commission, was addressed to Mr HW Du  
Plessis,   Digital   Healthcare   Solutions   (Pty)   Ltd   (Mr   Du  
Plessis   is   the   chief   executive   officer   of   DHS)   and  
contained   a   reference   to   case   no.   2001Mar13,   that   of  
Mediswitch (Pty) Ltd and QEDI (Pty) Ltd. 11The reasons  
for the apparent breach were stated as follows:
“The   Commission’s   conditional   approval   of   the   merger   specifically  
provided that DHS should conclude an agreement with any party that  
initiated   negotiations   with   it   within   sixty   days   of   receipt   of   a   written  
request  by the aforesaid party.  In the instant case, DHS received a  
formal request from Healthbridge on 4 June 2001, erroneously dated 4  
July 2001. In terms of the Commission’s conditions, DHS should have  
concluded   the   agreement   with   Healthbridge   on   or   before   3   August  
2001.
DHS   has   been   in   breach   of   these   conditions   since   4  
August   2001.   The   Commission   had   allowed   DHS   to  
continue with  its negotiations with  Healthbridge in  the  
10  S.   27(1)(c)   of   the   Act   states   that   the   Tribunal   may   “hear   appeals   from,   or   review   any  
decision of, the Competition Commission that may, in terms of this Act, be referred to it.” That is

the most general express reference in the Act to the Tribunal’s powers of review. e read s. 27(1)
(c) as requiring us to find a reference in the Act itself, or in regulations issued under the Act, to a  
possible review by the Tribunal of any particular type of decision of the Commission before a  
power to review a decision of that type can be said to exist as a matter of course. Such a power is  
explicit   under   rule   39(2)(b)   of   the   rules   of   the   Commission   in   relation   to   a   decision   of   the  
Commission to  issue a notice  of apparent  breach of  a merger  condition. We read  rule 42 as  
essentially procedural and not as conferring any independent power of review.
11  See page 29 of the record.
9

hope   that   DHS   and   Healthbridge   would   conclude   an  
agreement before the 23 rd of May 2002.
In light of DHS failing to conclude a contract by the 23 rd 
of   May   2002   and   its   shareholders   insistence   that  
Healthbridge’s   shareholders,   Discovery   and  
Medscheme, give DHS back end access to their systems  
in order to reach an agreement represents a breach in  
the conditional approval and this has necessitated that  
the Commission issue the CC19.“
DHS’ points  in limine
33.The two points   in limine which had been raised by DHS  
were argued at a hearing on 20 August 2003.
34. In the first, DHS asserted in effect that the Commission had cited the  
wrong party in the notice. DHS claimed that the error lay in the fact that  
the   notice   had   been   addressed   to   DHS   whereas   the   merged   entity  
comprised Mediswitch (Pty) Ltd, now DH Switch, which had absorbed  
the business of QEDI (Pty) Ltd. DHS was not, it contended, the merged  
entity.
35. Several factors were relied upon by DHS in support of this objection.
36.First,  it  was  pointed  out   that  the  Commission’s  notice  
requiring   notification   of   the   merger   was   directed   to  
Mediswitch   and   QEDI   (Pty)   Ltd,   not   to   DH   Switch’s  
holding   company,   DHS.   The   merger   was   notified   by  
Mediswitch   and   QEDI   (Pty)   Ltd,   not   by   DHS.   The  
conditions   for   approval   of   the   merger   were   moreover  
directed   at   Mediswitch,   not   DHS.   The   notice   was,   in  
DHS’s   submission,   correctly   addressed   to   DHS   as   the  
“spokesman”   or   “messenger”   for   DH   Switch,   and  
correctly referred to the original parties to the merger,  
but wrongly alleged a breach by DHS. DHS, Mr Burger  
contended,   was   “never   in   a   debate”   with   the  
Commission.   As   a   matter   of   company   law,   he  
contended, there had been an error. He contended that  
10

the   case   of   Dadoo   v.   Krugersdorp   Municipal  
Council1920 AD 530 at 550­1 was in point in ruling that a  
company is a separate entity from its shareholders and  
that property vested in the company cannot be regarded  
as vested in the shareholders. 
37. The evidence showed, said Mr Burger, that DH Switch  and  MM  are  
under   the  control   of  different   chief   executive  officers   and   boards   for  
purposes   of   their   day­to­day   operations.   The   Commission’s   merger  
clearance   document   had   wrongly   identified   Mediswitch   as   the   entity  
which controlled the PMAs, whereas the correct entity was MM. The  
Commission’s   merger   clearance   document   and   notice   of   apparent  
breach had been directed specifically to named companies and not to  
an  “acquiring  firm”  in  terms  of  the   definition  of   that   term   in  the   Act,  
which would have covered a wider group than merely the companies  
named in these documents. 
38. The “merged entity” to which the Commission referred in its documents  
could only be DH Switch and not DHS. He refuted the suggestion that,  
since the evidence showed that the conditions for the merger had been  
drawn up collaboratively by the Commission and the merging parties,  
his   argument   about   the   non­involvement   of   DHS   in   the   activities  
alleged by the Commission to amount to a breach had the implication  
that the Commission might have been given incorrect information about  
the   circumstances   of   these   entities   by   one   or   more   of   the   relevant  
companies at the time when the merger was approved, and this might  
not   have   led   to   approval   of   the   merger   subject   to   the   particular  
conditions imposed. All that the conditions required, he contended, was  
that DH Switch use its best endeavours or reasonable endeavours to  
get its fellow subsidiary, MM, to comply with the conditions. That fact  
that MM might be “difficult” was not to be blamed on the “sometimes

that MM might be “difficult” was not to be blamed on the “sometimes  
competing” entity, DH Switch.
39.The   Commission’s   attitude   to   this   point   in   limine , 
advanced by Mr Coetzee, was that it was irrelevant how  
the acquiring and target entities of the merger organised  
themselves internally, and the Commission was entitled  
to   address   the   complaint   about   an   alleged   breach   to  
DHS   as   the   holding   company   of   the   entity   which   had  
committed the alleged breach. DHS was the “controlling  
mind”   of   the   two   entities,   DH   Switch   and   MM.   The  
Commission, he said, looked to the entity which could  
give effect to the conditions. If it had expected MM to on  
11

its own give effect to the conditions it would not have  
issued the conditions in the wording in which they were  
in fact issued.
40. HB’s approach, argued  by Mr Unterhalter, was that DHS was  on its  
own evidence, as set out in a supplementary affidavit by Mr Du Plessis,  
the entity which represented DH Switch and MM in matters of strategic  
importance,   such   as   in   “dealing   with   lawyers”   and   “ensuring  
compliance   with   regulatory   authorities”.   On   this   basis   the   regulatory  
entity to be addressed by the Commission was DHS.  If the objection to  
the notice had been anything other than opportunistic, the correct entity  
to have brought the review application would have been DH Switch, not  
DHS, since DH Switch would have considered the obligations of the  
conditions to rest on it, not on DHS. 
41. However,   said   Mr   Unterhalter,   DHS   had   understood   fully   that  
obligations contained in the conditions had rested on it since DHS had  
substantively sought to answer  for  the merged entities in the review  
application under Rule 39. In any case, DH Switch (then Mediswitch)  
was never in a position to control, and did not own, the PMAs referred  
to in the conditions, so other entities have obviously been implicated  
from the start. DHS had at the relevant time been named MediSwitch  
Holdings   (Pty)   Ltd,   so   the   term   “Mediswitch”   in   the   Commission’s  
merger clearance document and in the notice of apparent breach was  
always “potentially an ambiguous term”, and what was clearly intended  
in   the   notice   was   a   group   of   companies   aligned   together   for   the  
purpose of the deployment of the PMAs. 
42.It   was   clear   from   the   reference   to   “control”   in   the  
conditions,   said   Mr   Unterhalter,   that   what   was   being  
referred to was a group of entities going wider than DH  
Switch.   In   that   group,   DHS   exerted   control   in   the

Switch.   In   that   group,   DHS   exerted   control   in   the  
classical   sense   of   owning   the   shares   in   the   operating  
companies.   All   these   companies   were   implied   in   the  
term “the merged entity” as used in the Commission’s  
merger   clearance   document   and   in   the   notice   of  
apparent   breach.   This   was   confirmed   by   the   fact   that  
DHS   had   supplied   the   Commission   with   quarterly  
reports   on   the   process   of   integrating   other   switch  
entities, and had used in relation to its reports the words  
“in   compliance   with   the   third   condition   set   out   in   the  
merger   clearance   certificate.” 12This,   it   was   contended,  
12  See page 937 – 945 of the record.
12

was a clear admission that the merged entity included  
DHS.
43. Mr Unterhalter further referred to the definition in the Act of “acquiring  
firm”, which includes the upstream and downstream associates of the  
parties to a merger, and submitted that the term “merging party” had to  
be   interpreted   in   the   same   context,   wider   than   the   identity   of   the  
individual company which was a party to the merger agreement. The  
key point in the conditions was the control of the software, and it would  
have been inappropriate and illogical to impose the conditions only on  
Mediswitch,   which   did   not   technically   control   the   PMA   software.  
Consequently, it was artificial and wrong, HB contended, to interpret  
the conditions and the notice in the manner argued for by DHS. 
44. The Tribunal is satisfied that the stance of the Commission and of HB  
on this issue is correct, and that the reasons advanced by them in their  
arguments   are   essentially   sound.   We   consider   that   the   conditions  
imposed by the Commission must be read as referring to and being  
addressed to entities, which could give proper effect to the conditions. 
45.The Commission, as noted, imposed  the conditions in  
its   merger   clearance   decision   on   the   “merged   entity”.  
The   words   “merged   entity   “   are   not   used   in   the   Act,  
which refers instead to a “party to a merger”. The Act  
defines a “party to a merger” as an “acquiring firm” or  
“a target firm”. These two concepts are further defined  
but   as   these   definitions   are   lengthy   they   need   not   be  
reproduced here. It suffices to say that DHS would meet  
the definition of an acquiring firm in the Act. It follows  
that   this   would   make   DHS   a   “party   to   the   merger”   as  
defined,   and   thus   subject   to   the   consequences   in   the  
Act for firms of that status –  inter alia , the duty to notify  
a   small   merger   when   so   required   by   the   Commission

a   small   merger   when   so   required   by   the   Commission  
under   section   13(3)   and   the   duty   to   comply   with  
conditions imposed on that merger (section 59(1)(d)(iii).  
The   question   then   is:   when   the   Commission   imposed  
the condition on what it termed the “merged entity” did  
it restrict itself only to the legal entity that absorbed the  
target   firm   (DH   Switch)?   In   our   view   both   the   legal  
regime created by the Act for merger notification, which  
contemplates   a   wide   range   of   firms   as   parties   to   the  
13

merger,   as   well   as   the   logic   of   the   condition,   suggest  
that DHS was contemplated within the notion of “merged  
entity”.13(Would   the   Commission   have   intended   to  
impose a condition on a firm incapable of implementing  
it?)
46.In the circumstances of the group structure of DHS, DH  
Switch,   and   MM,   and   the   changes   in   name   and  
shareholding which took place in these companies as a  
result   of,   or   after,   the   merger,   this   means   that   these  
companies   are   included   in   the   concept   of   the   merged  
entity affected by the conditions. It seems clear from the  
evidence that this was understood by DHS in the same  
way.   In   the   post­merger   activities   of   relevance   in   this  
case those entities were represented by DHS in dealings  
with   the   Commission   and   with   HB.   There   is  
uncontradicted evidence by Mr Van Zyl, the CEO of HB,  
that   at   the   very   outset   of   HB’s   negotiations   to   secure  
integration   for   HB   with   the   PMAs   supplied   by   MM   he  
approached   the   CEO   of   DHS,   Mr   Du   Plessis,   who  
insisted   that   the   negotiations   proceed   with   him   rather  
than with the managing director of MM, and that he (Du  
Plessis) had the necessary authority to take the matter  
further.14
47.It is also clear to the Tribunal that the point  in limine is a  
comparatively novel weapon in DHS’ armoury. In a letter  
dated 28 August 2001 (p. 96 of the record) sent by Du  
Plessis on behalf of DHS to HB – clearly a considered  
13  It was argued by Mr Campbell for DHS in reply during the hearing that the notice to notify was  
addressed only to Mediswitch (Pty) Ltd and QEDI (Pty) Ltd which, were hence the only parties obliged  
to notify and which could be made the subject of merger conditions. This argument is not correct. The  
Commission’s rules make it clear it is not obliged to serve its notice on every party to the merger: see

Rule 25(3) which states that notice to the primary acquiring firm (in this case Mediswitch) suffices.  
However both the Act and the Commission’s rules are clear that once given notice by the Commission  
“ the parties to the merger” must file a merger notification.  (See section 13(5), Rule 25(1) read with  
25(4)) Thus the choice of recipient of a form CC9 does not confine the Commission to consider only  
the primary acquiring and target firms as parties to the merger. The fact that parties must still notify  
after receiving a requirement to do so indicates that the Commission does not have all the information  
it would require and hence the onus to notify is put on the parties. Indeed the Commission in all  
likelihood, when issuing a CC9, may know no more than the identity of the contracting parties, which,  
as we have seen, are only a sub­group of firms contemplated as parties to a merger.
14  See page 294, par 12.2 of the record.
14

and   legalistic   letter   –   Du   Plessis   stated   unequivocally  
that “DHS is acutely aware of its obligations in terms of  
the   ruling   issued   by   the   Competition   Commission   in  
Notice 919 of 2001 and will comply with that ruling to the  
letter.”   Notice   919  contains   the   Commission’s  reasons  
for   approving   the   merger   and   its   conditions   for   the  
approval. 
48. It lies ill in the mouth of DHS and its counsel to argue at this stage that  
DHS was  somehow   not  affected by the conditions and  was  wrongly  
addressed by the Commission when it issued the notice of breach.
49.Consequently, the first point  in limine fails.
50.The   second   point   in   limine concerns   the   approach  
adopted by the Commission when it considered whether  
there   had   been   compliance   with   the   conditions.   DHS  
contended that the Commission had been inconsistent  
in that, while the conditions stipulated that the merged  
entity should use all reasonable endeavours to conclude  
the   agreement   contemplated   in   the   conditions,   the  
notice   of   apparent   breach   reflected   a   decision  
postulating an absolute obligation on DHS to conclude  
an   agreement   with   any   party   initiating   negotiations  
within 60 days from receipt of the request to negotiate,  
regardless whether such request was reasonable.
51. DHS  argued  that   the   Commission  had  been  obliged   to  consider  the  
reasonableness of the parties at three separate stages. First, when a  
written request was made to the merged entity, the request had to be  
reasonable. If the request survived this test, the second stage required  
the   merged   entity   to   use   all   reasonable   endeavours   to   conclude   an  
agreement within 60 days of receiving the request. There was no rigid  
requirement   to   conclude   an   agreement;   merely   to   use   such  
endeavours to  conclude  an  agreement.     Finally,  the reasonableness

endeavours to  conclude  an  agreement.     Finally,  the reasonableness  
was   to   apply   only   in   regard   to   agreements   containing   commercially,  
financially and technically reasonable terms. The obligation to conclude  
the   agreement   would   arise   only   if   an   offer   were   made   to   DHS   that  
contained   terms   that   were   commercially,   financially   and   technically  
reasonable.
52. The Commission, so DHS contended, had merely taken the fact that no  
15

agreement had been signed by 23 May 2002 to be a breach of the  
conditions, and did not consider the reasonableness of both parties at  
each stage mentioned above. It therefore did not apply its mind to the  
real issues.
53. The   evidence   shows   that   HB   directed   a   request   to   DHS   for   an  
integration   agreement   in   a   faxed   letter   of   4  June   2001   (erroneously  
dated 4 July 2001), sent by Van Zyl to Du Plessis. This followed the  
telephone call from Van Zyl to Du Plessis mentioned above in which  
Van Zyl had broken the ice on the issue of the proposed integration  
agreement and had established that Du Plessis, and not the CEO of  
MM, was the person with whom HB was to negotiate.
54. Enclosed   with   HB’s   letter   of   4   June   2001   was   a   proposal   for   an  
integration agreement, in the sense of an agreement to connect HB via  
an API to the PMAs installed by MM with medical service providers,  
and   also   a   proposal   for   a  so­called   interswitch   agreement,   to   which  
reference will be made later. The proposal dealt at some length with  
the technical issues, as well as others, and it is accepted by DHS that  
the technical proposals were reasonable. There is a dispute about the  
reasonableness of the financial and commercial aspects. DHS did not,  
it seems, submit a detailed appraisal of HB’s proposals but instead, on  
18 June 2001, sent HB a set of counterproposals for the integration  
agreement.   Significantly,   they   contained   nothing   related   to   the  
interswitch issue. It  is clear to the Tribunal that DHS  did  not at that  
stage, and in fact in several rounds of negotiation that followed in the  
ensuring three months or more, raise the issue of interswitch, or link its  
proposals   for   an   integration   agreement   to   any   form   of   interswitch  
agreement. That came later.
55. There   is   a   lengthy   account   in   the   papers   of   the   negotiations   that

55. There   is   a   lengthy   account   in   the   papers   of   the   negotiations   that  
followed.   The   negotiations   became   acrimonious   and   accusations   of  
unseemly   conduct   appear   to   have   been   exchanged.   In   about  
September 2001 DHS came forward with the suggestion that DHS and  
HB might merge, and for some five months the two groups concerned  
engaged in a discussion about this possibility. It led nowhere since in  
the   end   it   was   concluded   that   there   were   insuperable   competition  
objections   to   such   a   merger.   Complaints   were   made   on   both   sides  
about allegedly unreasonable requirements which were being raised by  
their counterparts. The negotiations were foundering. 
56. HB   approached   the   Commission   and   alerted   it   to   the   state   of   the  
negotiations. DHS lodged a complaint with the Commission that there  
was anti­competitive activity in the HB camp in that Medscheme and  
Discovery   Health   would   not   allow   DHS   the   access   to   their   systems  
which it needed to be able to switch claims in real time directly to those  
16

administrators   –   so­called   “back­end   access”.   This   is   the   interswitch  
topic referred to above.
57. The   negotiations   were   protracted,   intense,   and   complex.   Several  
hundreds of pages of documents detailing the negotiations and what  
they   encompassed   were   filed.   It   is   not   easy   for   the   Tribunal   to  
summarise them adequately.
58. A few conclusions have however been drawn by the Tribunal from this  
welter of documents and the large amount of information they contain.  
These conclusions may be summarised as follows:
1) The   Commission   was   told   at   numerous  
stages   during   the   negotiations   of   the  
progress,   or   lack   of   progress,   which   had  
been   achieved.   The   Commission   was   in  
touch   with   DHS   and   HB   and   received  
reports independently from both of them. It  
considered   the   details   of   the   proposals,  
which   were   exchanged   at   the   time   when  
these   reports   were   made.   The  
Commission’s investigator in charge of the  
matter,   Mr   Chetty,   was   in   touch   with   both  
sides by telephone and in other ways and  
actively   followed   the   development   of   the  
negotiations. It is clear that he was applying  
his   mind   to   the   issues   under   discussion  
between DHS and HB. 
2) It   was   not   inattentiveness   or   indifference  
which governed the Commission in allowing  
the 60­day time limit stated in the conditions  
to   be   overtaken,   but   rather   the   belief   that  
there was a prospect that the negotiations  
would   succeed   and   would   result   in   an  
agreement which would make further action  
by the Commission unnecessary. 
3) The   Commission   was   aware   of   the  
restrictions   imposed   by   Medscheme   and  
Discovery Health  on  back­end  access and  
examined   these   restrictions   through   the  
lens   of   anti­competitiveness,   but   was   not  
perturbed   by   them.   In   any   case   the

perturbed   by   them.   In   any   case   the  
Commission   regarded   this   issue   as  
extraneous and irrelevant to the question of  
17

integration  of  the   HB  switching   technology  
with the PMAs supplied by MM.
4) The   proposal   for   a   merger   between   DHS  
and HB, or  parts of their  businesses, took  
up an inordinate amount of time and was ill­
considered in the light of the pressing time  
constraint on the merged entity ­­ in practice  
on   DHS   ­­   to   conclude   an   integration  
agreement. 
5) While the Commission was content to allow  
the negotiations to continue far beyond the  
stipulated   60­day   deadline,   it   was   clear   to  
all concerned that the Commission was not  
abandoning   the   conditions.   The   day   of  
reckoning   for   non­compliance   with   the  
conditions,   if   no   integration   agreement  
emerged from the negotiations, was merely  
being delayed, in DHS’ favour.
6) Another   switch   entity,   MediKredit,  
applied   to   DHS   for   an   integration  
agreement and concluded such an  
agreement.   It   did   so   on   terms,  
which   it   regarded   as   highly  
unfavourable to itself, which it had  
been forced to accept as it had no  
alternative.15The   Commission   was  
aware of MediKredit’s position and  
took   account   of   it   in   its  
consideration   of   the   status   of   the  
negotiations between HB and DHS.
59.In   the   light   of   its   conclusions   on   these   matters   the  
Tribunal is not persuaded that the Commission failed to  
apply its mind to the reasonableness of the negotiations  
in   any   significant   way,   and   certainly   not   in   the   three  
stages posited by DHS. It is correct that some passages  
in   the   notice   of   apparent   breach   suggest   that   the  
Commission   was   somewhat   abrupt   about   its  
15  See page 287 of the record. 
18

consideration   of   the   issues   and   its   decision   finally   to  
issue the notice. The notice must however be read as a  
whole.   The   second   paragraph   of   the   notice   refers  
explicitly to the fact that it is the failure to conclude the  
contract and the insistence on back­end access in order  
to reach an agreement that represents a breach of the  
conditional   approval.   Thus   the   Commission   does   not  
confine   itself   to   the   failure   to   reach   an   agreement   as  
constituting the breach, but couples this failure with the  
insistence   on   back­end   access.   Furthermore   there   are  
other   passages   in   other   documents   from   which   it   is  
clear that the issues were weighed in a careful and even­
handed   manner.   In   their   references   to   individual  
passages from the papers DHS’ counsel were selective  
rather than systematic. 16 
60. For example, DHS’ counsel made much of a statement in paragraph 41  
of the affidavit of Mr Chetty, who testified on behalf of the Commission,  
that: 
“The proof of reasonableness in these negotiations was the fact  
that no agreement was concluded between a willing seller and a  
willing buyer.” 
Mr Burger’s comment was that:
  “ That’s obviously reviewable. They haven’t applied their minds  
to it.”  
However, Chetty’s statement, which read in isolation, certainly tends to  
suggest that the Commission concerned itself more with the outcome  
than   the   nature   of   the   negotiations,   is   immediately   preceded   by   the  
statement that: 
“It   has   always   been   the   Commission’s   position   that   the   end  
result   of   these   endeavours   and   negotiations   should   be   a  
reasonable and mutually acceptable agreement.”  
It is clear from this passage that the Commission’s stance at the end of  
the day was that the nature of the negotiation process and the content  
of any agreement, which might have been reached were important, not

of any agreement, which might have been reached were important, not  
that the only factor it need take into account was the non­conclusion of  
an agreement. 
16  See Record page 167, second paragraph and page 841 paragraphs 18­19. 
19

61. In   paragraph   42   of   the   same   affidavit,   Chetty   moreover   makes   the  
statement that:
“It is submitted that what is at issue is the manner in which the  
negotiations were being conducted.” 
Mr Burger’s view on this statement was that it did not explain what the  
Commission had considered, and from this he proceeded to the conclusion  
that the underlying issues had not been addressed at all by the Commission.  
In replying argument, Mr Campbell dismissed this statement as “a throw­away  
line”.
62. The above­quoted statements of Chetty are of course  ex post hoc  statements. We did  
not hear from DHS’s counsel any discussion of paragraphs 39 to 55 of Du Plessis’  
founding   affidavit   and   the   annexures   to   it   relevant   to   those   paragraphs.   In   these  
paragraphs (at pages 13­18 of the record) Du Plessis describes various stages in the  
negotiations with HB. 
63. Du Plessis mentions in paragraph 43 that Chetty telephoned him on the 6 th of March  
2002 and revealed that HB had lodged a complaint with the Commission about the  
lack of an integration agreement. Du Plessis testifies about a number of other topics  
discussed   in   that   conversation,   all   being   at   that   time   recent   developments   in   the  
negotiations. Chetty clearly played an active role in this conversation. He was taking  
an   interest   in   the   status   of   the   negotiations   and   was   receiving   and   conveying  
information about them. He was obviously giving consideration to the progress being  
made   towards   an   agreement,   and   taking   account   of   various   submissions   of   the  
parties to the negotiation process.    
64. In paragraph 45 an account is given of a meeting, which Du Plessis  
and DHS’ attorney had with three representatives of the Commission,  
Chetty being one of them. It was clearly a detailed report­back meeting  
at   which   DHS’   presentation   of   the   facts   did   not   satisfy   the  
Commission’s team.

Commission’s team.
65. Further   telephone   conversations,   which   Du   Plessis   had   with   the  
Commission   about   various   features   of   the   negotiation   process   are  
explained   in   paragraphs   47   and   55   of   Du   Plessis’   affidavit.   In  
paragraph   48   Du   Plessis   describes   the   receipt   of   a   letter   from   the  
Commission dated 9 May 2002 in which the Commission sternly warns  
DHS   of   its   concern   that   DHS’   insistence   on   back­end   access   to  
Medscheme and Discovery Health was regarded by the Commission  
as a failure to comply with the terms of the merger approval. 
66. These   passages   from   the   papers   received   no   attention   in   DHS’s  
submissions   at   the   hearing.   They   clearly   undermine   entirely   DHS’  
protestations that the Commission did not apply its mind to the issues.  
In   any   event,   the   issues   as   explained   in   DHS’   submissions   were  
20

clouded by DHS’ analysis and interpretation of the conditions, which  
are dealt with more fully in a later part of this decision and which are  
rejected by the Tribunal.
67. The Commission conceded at the hearing that it might have phrased  
some of its documents more satisfactorily, but the lapses of which we  
are   aware   are   minor   and   are   self­evident   and   do   not,   in   our   view,  
outweigh the overall impression that the matter was approached in a  
fair and attentive manner by the Commission. 
68.It   is   also   artificial   to   approach   the   Commission’s  
discretion in this case in a static manner, as if it heard  
all   the   facts   on   a   once   off   basis   and   then   made   a  
decision.   The   record   shows   that   the   Commission  
continuously   monitored   the   implementation   of   the  
conditions;  it received quarterly reports from DHS and  
had   interaction   with   other   players   including   HB.   Its  
decision   is   thus   formed   on   the   basis   of   what   it   was  
experiencing over a long period of time. Had it issued its  
notice of apparent breach on the 61 stday after HB had  
formally   requested   the   conclusion   of   an   integration  
agreement, DHS’ arguments might have had more force.  
The   fact   that   it   allowed   the   parties   further   time   to  
negotiate shows that  the Commission  was at all times  
alive   to   the   more   nuanced   interpretation   of   the  
conditions for which DHS contends. 
69.It is also worth noting that in terms of the rules of the  
Commission, the explanation accompanying  the notice  
of   apparent   breach   is   intended   to   be   a   succinct  
explanation of the errant conduct rather than a carefully  
reasoned judgment.  17
70.HB’s approach to this point   in limine was that issuance  
by the Commission of the notice of apparent breach was  
merely an interim step in a decision­making process and  
was not the kind of action which was reviewable on the

was not the kind of action which was reviewable on the  
grounds   that   the   Commission   had   failed   to   apply   its  
17  The form states,  “It appears to the Commission that you have breached an obligation that was part  
of the approval of your merger as noted on the attached sheet.”
21

mind   to   the   question   whether   there   had   been  
compliance   with   the   conditions.   (This   approach   is  
consistent   with   the   Tribunal’s   own   jurisdictional  
reservations as set out earlier in this decision.) 
71.Second,   HB   contended   that   it   was   plain   that   the  
Commission issued the notice of apparent breach after  
fully   considering   the   relevant   factors.   It   could   not  
therefore be accused of not applying its mind to them.  
Alternatively, HB suggested that the issues raised in this  
point   in limine went to the heart of the case and should  
be dealt with only after evidence on it had been led.
72.The Tribunal has, as was stated above, assumed in DHS’  
favour, for the purposes for this decision, that it has the  
review   powers   contended   for   by   DHS.   It   considers  
however that the second point  in limine is without merit.  
Far from the Commission  not applying  its mind to the  
issues,  it   appears   to   the  Tribunal  that   there   is   a  good  
showing on the papers that the Commission repeatedly  
applied its mind to those issues and to ancillary issues  
pressed upon it by DHS, and perhaps also by HB, and  
was   at   all   relevant   times   mindful   of   the   state   of   the  
negotiations and reasons for their status at various time.  
In saying that it considered that there had been a breach  
of   the   condition   because   no   agreement   had   been  
concluded by 23 May 2002 between a willing buyer and a  
willing seller, the Commission was merely expressing in  
a   somewhat   roundabout   way   its   conclusion   that   the  
failure   of   the   negotiations   was   attributable   to   lack   of  
reasonableness on the part of DHS. 
73.Accordingly, the second point  in limine also fails. 
74.The   Tribunal   issued   an   order   on   22   October   2003  
dismissing the points  in limine and reserving the costs in  
regard to them. As had been arranged, argument on the

regard to them. As had been arranged, argument on the  
remainder of the case was heard on 21 November 2003.
22

75. An application was filed by the Commission on 5 November 2002 for  
leave   to   introduce   the   opinions   on   its   behalf   of   an   expert,   Ms   Lori  
Baker,   and   for   consent   that   she   be   granted   access   to   DHS’   expert  
reports,   for  which  DHS   has   claimed   confidentiality.  The   Commission  
withdrew   this  application  at   the  hearing   on   21  November  2003   after  
DHS   had   given   notice   that   it   intended   to   oppose   the   application.   A  
decision on the issue of the costs of the withdrawn application, which  
were claimed by DHS, was reserved.
76. The   matter   proceeded   on   21   November   2003,   with   Mr   Burger  
presenting DHS’s case on the merits of its application. 
77. Immediately   after   the   mid­morning   break   Mr   Burger   announced   that  
DHS   was   applying   for   the   recusal   of   Mr   Phatudi   Maponya   from   the  
panel   of   the   Tribunal   which   had   heard   the   matter   up   to   then.   The  
grounds for this application were stated to be that DHS’s attorney had  
during the break become aware for the first time that Mr Maponya had  
some   relationship   with   the   Pretoria   law   firm,   Maponya   Inc.,   which  
practises in a form of association with the law  firm Webber Wentzel  
Bowens,   which   has   acted   throughout   the   matter   for   HB.   Mr   Burger  
stated   that   this  had   led  to   a  perception   on  the   part   of  DHS   that  Mr  
Maponya  might  be  subject   to  a  conflict  of  interest.  He stressed  that  
there   was   no   allegation   that   DHS   had   been   prejudiced   by   Mr  
Maponya’s participation in the panel thus far. Mr Burger undertook on  
behalf   of   DHS   that   it   would   not   attempt   to   invalidate   any   of   the  
preceding proceedings or decisions of the Tribunal in the matter on the  
ground that Mr Maponya had participated in them.
78. Mr Maponya explained that he was no longer a partner in the law firm

78. Mr Maponya explained that he was no longer a partner in the law firm  
Maponya   &   Partners   and   was   merely   a   consultant   to   it   on   various  
matters. However, in view of the fact that the issue had been formally  
raised, he recused himself from the panel with immediate effect.
79. Another member of the panel, Mr Lawrence Reyburn, pointed out that  
he had at one time been a partner in Webber Wentzel Bowens and  
later a consultant to it, but had resigned and no longer had a formal  
connection   with   that   firm.   Mr   Burger   announced   that   there   was   no  
objection by DHS to Mr Reyburn’s continued participation in the panel.
80. A direction from the chairperson of the Tribunal was then sought under  
s. 31(3)(a) of the Act as to whether the matter should proceed to finality  
before the presiding member, Mr Norman Manoim, and Mr Reyburn, as  
a   two­man   panel.   The   direction   was   duly   given   and   the   hearing  
continued on that basis.
81.Mr   Burger   contended   that   the   review   application   in  
23

respect of prayers 1 and 2, on the alternative basis set  
out in the amended notice of motion (that is, under s. 27  
of the Act read with rule 47 of the rules of the Tribunal),  
was   still   to   be   decided   despite   the   Tribunal’s   earlier  
decision on the second point  in limine .  
82.The   Tribunal   does   not   accept   this   contention.   It  
considers   that   its   decision   on   the   second   point   in  
liminedisposed   of   all   the   review   issues   except   those  
dealt with in the remaining part of this decision.
L Reyburn
Concurring: N Manoim
Did the applicant substantially comply with the conditions?
83. In this section of the decision, we ask whether DHS has substantially complied with  
the conditions for the approval of the merger: If the answer to that question is yes,  
then the Rule 39 notice must be set aside. If the answer is no, then the Commission  
is   entitled   to   proceed   with   the   further   procedural   steps   that   its   rules   contemplate,  
consequent on a determination that there has been a breach of merger conditions. 18
84. It is common cause in this application that –
• HB is a healthcare switch entity as contemplated in paragraph 1  
of the conditions; 
• HB made a proposal for its switch technology to be integrated  
with a PMA package controlled by DHS, and this proposal was  
refused;
• DHS made a counter­offer to HB which the latter refused;
• the   parties   had   protracted   but   unsuccessful   negotiations  
concerning access;
• at the time of the issuing of the notice of apparent breach, and  
indeed to date, no agreement has been reached between DHS  
and HB to grant it access to the former’s PMA software. 
85. On all other issues the consensus breaks down. First there is disagreement on how  
the conditions should be interpreted. This essentially boils down to a dispute over the  
18  The Commission’s rules provide for an elaborate procedure for post­breach enforcement. See Rules  
39­40
24

extent   to   which   HB   was   under   an   obligation   to   make   a   reasonable   proposal   for  
access   ­   with   DHS   seeking   to   elevate   the   extent   of   this   obligation,   and   the  
Commission and HB seeking to diminish it. Secondly, and more fundamentally, the  
parties disagree over what an agreement containing “reasonable terms” means. 19 
This second disagreement can be distilled again into whether “reasonable terms” are  
to be  assessed from  their effect on the commercial  interests of  DHS i.e.  would a  
reasonable, prudent business person in the same position as DHS have entered into  
such an agreement? If this is what “reasonable terms” means, then DHS’ offer of  
June 2002 to HB, which the latter refused because it alleged that it exceeded what  
the   market   would   consider   “reasonable”’,   may   nevertheless   from   this   subjective  
vantage­point,   viz.   the   protection   of   the   commercial   interests   of   the   firm   granting  
access, be reasonable. So too would DHS’ insistence that an access agreement must  
be predicated on reciprocal back­end access. 
86. On   the   other   hand,   if   HB   and   the   Commission   are   correct,   the  
conditions   must   not   be   approached   from   the   perspective   of   DHS’  
commercial interest, but from what are reasonable terms for a rival to  
be granted access, and for reasonable terms read in “market­related”  
terms. They further argue that the insistence on back­end access is an  
extraneous   issue   and   that   it   evidences,   if   anything,   DHS’  
unreasonableness. 
87. In its replying heads, DHS contends that it is common cause that the  
Commission’s   conditions   are   unambiguous.   This   is   a   remarkable  
statement given the length of the record on this point. At best it can be  
said that each side has shown confidence in its own reading ­ the fact  
that   these   readings   yield   such   different   results   suggests   that   the

that   these   readings   yield   such   different   results   suggests   that   the  
interpretation of the order is no simple matter.
88. The source of the dispute created by the language of the conditions is the frequent  
use in the first two paragraphs of the word “reasonable”’ to qualify various obligations.  
The first two paragraphs are replete with the word, which the drafters seem to think  
needed to be inserted in every crevice where it could sensibly fit, limited only by the  
constraints of syntactical coherence. Its usage has largely led to the dispute we have  
today. It was not however the Commission’s initial choice of language. Indeed the first  
draft proposed by the Commission that appears in the record omits the word. 20  It  
was   only   when   the   lawyers   representing   the   merging   firms   responded   to   that  
proposed draft that this word was inserted with such abandon, at their suggestion. 21
89. As we indicated earlier, the first dispute arising from the interpretation  
of the conditions is what the extent was of the obligation on the party  
making   what   the   order   terms   “a   reasonable   written   request”.   DHS  
argues   for   a  conjunctive   reading   of   the  two   paragraphs,  so   that   the  
reasonable request is also one subject to terms that are reasonable  
commercially,  financially  and  technically.   (Mercifully  in   this  case   it  is  
also common cause that both offers were technically reasonable, so  
19  We will refer to “reasonable terms” as shorthand for the more extended language of reasonableness  
contained in paragraphs 1 and 2 of the Commission’s conditions, cited earlier. 
20  See record page 843.
21  See record page 836.
25

this issue is off the table.) The request need not contain the terms of a  
full­blown agreement, but it seems what DHS has in mind are the core  
terms, perhaps sans the “boiler plate” clauses that are standard fare in  
most written contracts of this nature. Until a request of this nature has  
been made, so DHS argues, it is under no obligation to respond.  Put  
another   way,   it   is   a   necessary   precondition   before   it   incurs   any  
obligation in terms of clause 2. On this approach it argues that since  
the HB offer contained terms that were not commercially reasonable its  
request failed to trigger any concomitant obligation from DHS.
90. In   contrast   HB   argues   that   the   two   paragraphs   must   be   read  
disjunctively. All that is required is that the request be reasonable. In  
argument Mr Unterhalter suggested that this meant no more than:
“…   that a party with clear commercial intent, wanting to enter into a contract, sends a  
request  for the kind of interconnection  that is contemplated  in the condition, then the  
obligation is triggered”  
and that the phrase “commercially, financially and technically” does not qualify the  
request.22 Indeed this is why this language is not found in the first paragraph, which  
is the one that deals with the request, but only in the second paragraph, which is the  
one that deals with the merged firm’s obligations.
91. Interesting though this debate has been, we need not decide it. Even if  
we accept DHS’ contention, although we have doubts about it, we find,  
for reasons that we explore more fully below, that HB’s offer contained  
commercially, financially and technically reasonable terms. Given that  
finding,   the   debate   over   what   obligation   HB   had   in   terms   of   the  
conditions is rendered academic.
92. What we must decide is the second part of the debate and that is the  
content to be given to the word “reasonable”. Again this debate can be

content to be given to the word “reasonable”. Again this debate can be  
distilled   further   into   the   meaning   to   be   attributed   to   the   term  
“commercially reasonable”.
93. Mr Burger made much of this term for reasons that become clear later.  
Several aspects of his argument are in our view uncontentious. One is  
that since the term “commercially reasonable” is used in the condition,  
as something distinct from “financially reasonable”, it must be given a  
distinct   meaning,   which   would   suggest   it   refers   to   terms   other   than  
purely financial ones such as price. 
94. The next is that when the conditions refer to a “reasonable agreement”  
it   must   contemplate   a   range   of   possible   agreements   that   could   be  
described as reasonable.   It is perfectly clear that agreements of this  
kind are subject to variation and complexity and that more than a single  
22  See page 102 of the transcript dated 21 November 2003.
26

form   would   meet   the   test.   Thus   within   the   realm   of   reasonable  
agreements that meet the test, there may be one preferred by DHS,  
but not by HB, and vice versa. Provided DHS can prove it offered one  
that was in the range of what may be termed reasonable, albeit HB  
may   have   rejected   the   offer,   it   has   substantially   complied   with   the  
conditions. DHS might  even be compliant if  it rejected a reasonable  
offer from HB provided of course it responded with a reasonable offer  
from its own side. 
95. However   it   is   the   next   leg   of   Mr   Burger’s   argument,   which   is   the   real   source   of  
contention in this application. He builds on the term “‘commercially reasonable” to  
found a case for rejecting HB’s offer, defending DHS’ offer of June 2001, which HB  
rejected, and asserting the demand for back­end access. Essentially what he argues  
is   that   DHS   is   not   obliged   by   the   conditions   to   enter   into   an   agreement   that   is  
commercially harmful to it. In this respect he argues that harm means harm to the  
DHS entity as a whole, not just Med­e­mass, the entity that would grant access.    2323 
96. What DHS argues is that it would never in the ordinary course give  
access to a competitor in the position of HB, as opposed to any other  
competitor   which   is   less   threatening   to   it,   unless   it   got   something  
substantial   back.   Thus   if   it   can   prove   it   would   never   enter   into   a  
particular transaction in the ordinary course of business because it did  
not benefit the group to do such a deal, then it would, it follows, be an  
unreasonable deal – unreasonable being judged from the perspective  
of what would a rational firm, similarly circumstanced, do. If this proxy  
firm would not enter into an agreement on those terms because they  
would be irrational then such an agreement is commercially irrational  
and it would not be reasonable to expect DHS to enter into such an  
agreement.

and it would not be reasonable to expect DHS to enter into such an  
agreement.
97. For this DHS relies on the testimony of its expert, Mr Magennis. We go  
on to consider, in the next section, the reports of both Mr Magennis and  
the experts for HB.
The expert reports
98. We received expert reports from both DHS and HB. As was mentioned  
above,   although   the   Commission   applied   to   tender   its   own   expert  
report,   it   abandoned   this   application   in   the   face   of   opposition   from  
DHS. 
23  We observe in passing that it suited DHS to have the point  in limine  decided in advance, so that it  
could advance arguments in respect of the merits wholly at odds with its  in limine  contentions. The  
argument that the merger is only binding on DH Switch, which could not tell its sister or parent what to  
do, as a matter of strict company law is wholly inconsistent with the evidence of the applicant’s expert  
who urges us to interpret the commercial viability of the order by reference not to Med­e­Mass alone,  
as a separate company in the group, but DHS as whole.
27

99. Initially at the pre­hearing on 15 August 2003 we were advised by counsel for both  
HB and DHS that each side would call one or more experts to deliver oral testimony.  
When   we   heard   argument   on   the   points   in   limine   on   20   October   2003,   counsel  
advised us that the parties had agreed that there was no need to call the experts for  
oral testimony and that, provided each side’s expert could have an opportunity to file  
a report in response to the other, this would suffice. This procedure was followed.  
Although we also received a report from Deloitte and Touche on behalf of DHS and  
on behalf of HB a report from Louis van Deventer of HAS Software Pty Ltd, these  
reports have not been considered separately except to the extent that they have been  
relied on by what we will refer to as the principal experts. 24
100.The principal expert for DHS was Mr Reg Magennis from Elixir Health  
Consulting, and for HB it was G:enesis. Both filed an initial report and  
subsequent   to   that   a   second   report   responding   to   the   other’s   initial  
report.
Magennis’ initial report
101.In his initial report Magennis concludes that:
“DHS will lose  its switching business over  time  if Healthbridge  is granted  (or  is  
allowed  to retain)  “front­end”  access  without granting  DHS “back­end”  access  to  
Discovery and Medscheme systems to facilitate real time electronic trading.”   25
102.Based on this assumption, he concludes that if DHS were to develop a charge for  
front­end access, under circumstances where it is not granted back­end access, it  
would be appropriate to compute such a charge based on the losses incurred by DHS  
Switch, and thus the DHS Group, if its switching business is partly lost to HB. 26  He  
works through what he assumes these costs to be and then concludes, going further  
and assuming DHS’ switch business is lost entirely, that: 
“..therefore a case can be made for charging HB up to R436,50 per Med­e­

“..therefore a case can be made for charging HB up to R436,50 per Med­e­
Mass   serviced   site   in   a   scenario   where   DHS   is   forced   to   compete   in   an  
environment where the playing fields between DHS and   HB are not level.”  
27
(This charge of R436,50 is made up of R117,50 to compensate  
for Med­e­Mass’s costs plus an amount of R319 to compensate  
for the loss of business to DH Switch).
103.He thus concludes: 
24  DHS’s counsel, in their heads of argument, placed little reliance on the Deloitte and Touche Report.  
There is a reference to it in par 22.2.1, page 58 of their Heads, but this aspect is also referred to in the  
Magennis report. 
25  See Record, page 1033. (Page 32 of his first report)
26  See Record, page 1033.
27  See Record, page1035.
28

“ in the author’s opinion the proposed monthly charge of R130  
per site for Med­e­Mass integration is sufficient to place Med­e­
Mass in a position to sustain its profitability without the revenue  
and   costs   benefits   that   are   derived   from   its   linkage   with   DH  
Switch.   In   fact   R117,50   would   be   adequate   for   this   purpose.  
However   a   further   amount   of   up   to   R319   per   site   would   be  
required to compensate DHS if its DHSwitch business is lost.  
The DHSwitch business is likely to be lost if it does not enjoy the  
same  ‘back­end  privileges’  at  Medscheme  and  Discovery  that  
are enjoyed by HB.
Therefore the price of R130 (with a minimum annual charge of R100 000) for  
all sites) proposed by the DHS subsidiary Med­e­Mass for integrated access  
to its front end software is not unreasonable.”  28
G:enesis initial report 
104.G:enesis   commences   by   defining   what   it   understands   reasonable   to   mean.   It  
observes that the word ‘reasonable’ is not a term of art in economics or in competition  
analysis but that since the language is used in the context of competition policy and  
more   specifically   merger   approval,   this   is   the   context   to   “shade   and   inform   its  
practical   meaning”.   Given   this,   G:enesis   proposes   an   interpretation   formulated   as  
follows:
”DHS is obliged to accept an offer from a switch that would reasonably reward it for  
costs incurred in providing access (i.e. be “financially and commercially reasonable’)  
and that would be technologically feasible and stable (“ technically reasonable”). 29
105.With   this   interpretation   as   its   point   of   departure   G:enesis   then  
conducted two exercises to test the reasonableness of the HB offer to  
DHS. The first exercise tested whether the HB offer was reasonable in  
that it accorded with market norms in the sector for granting of access.  
The second exercise was to test whether the HB offer conformed to

The second exercise was to test whether the HB offer conformed to  
“reasonableness”   by   providing   a   reasonable   reward   to   DHS   for   the  
costs of access. The distinction between the two is that in the latter  
exercise the costs of the firm granting access may be unreasonable,  
because of its own possible inefficiencies, and hence the need to test  
these costs to see if they accord with market norms.
106.As   part   of   the   first   exercise   (the   accordance   with   market   norms   test)   G:enesis  
examined 32 contracts between various switches and PMA’s.  30 After reviewing the  
figures which are set out in its report, G:enesis comes to the conclusion that not only  
28  See Record, page 1036
29  See Record, page 1052
30  The switching companies were HB, Qedi, MediSwitch and Medi­Kredit. See Record, page 1057
29

did the HB offer fall comfortably within market practice but that the transaction fees it  
offered are at high end of the market. 31
107.G:enesis   then   goes   on   to   assess   the   impact   of   the   offer   on   Med­e­Mass. 32 
Significantly,   as   this   is   the   major   point   of   departure   between   it   and   Magennis,  
G:enesis states that it does not take into account the impact of the offer on DHS’  
switching business as this: 
“.. would defeat the purpose of the exercise if HB had to fairly compensate DHS for  
loss of business,”  33
108.G:enesis   then   concludes   that   the   HB   offer   was   lucrative   for   DHS,   even   using  
conservative estimates. Med­e­Mass, it says, would have profited significantly from  
the offer. 34
109.After having completed its two exercises and finding that the HB offer  
was reasonable on both tests, G:enesis then went on to test whether  
the   DHS   offer   was   reasonable,   of   course   based   on   the   same  
assumption   of   what   “reasonable”   meant   as   we   referred   to   earlier.  
G:enesis examines the terms of the DHS offer. It identifies four main  
characteristics of this offer:
1. HB has to pay DHS a R120 per month as minimum value per  
site. This fee would escalate by 10% each year;
2. The fee referred to above was subject to a minimum monthly  
fee of R120 000 (escalating by 10% per year) even if the roll­
out of sites did not reach 1000. 
3. In   terms   of   the   proposed   contract,   however,   DHS   was   only  
obliged to roll­out 420 sites within seven months. In addition  
HB could  not  select  the  sites  at which the  installation would  
occur. HB would only discover after installation at which sites  
installation occurred.
4. HB pays an integration fee of R380 per hour and an installation  
fee of R300 per hour.
110.G:enesis then analyses the implications of each of these terms and concludes that  
not only was the DHS offer not in line with market norms, but that it was in fact even

not only was the DHS offer not in line with market norms, but that it was in fact even  
more   unfavourable   than   those   contained   in   the   agreement   with   MediKredit,   an  
agreement which Genesis says is not a market­related agreement, but contains terms  
that exemplify DHS’s ability to exercise post­merger market power over MediKredit.  
(Recall that the MediKredit agreement is the only one that had been concluded by  
DHS with another switch as part of compliance with the terms of the Commission’s  
order.   In   a   letter   to   the   Commission   MediKredit   complains   about   these   terms   but  
31  See Record, page 1064.
32  See Record, page 1064.
33  See Record, page 1065.
34  See Record, page 1071
30

states that it had no choice but to accept them.) 35
111.Genesis concludes that the DHS offer was not in line with market norms nor indeed  
was the MediKredit agreement, and would result in a massive increase in the price  
charged for access. Genesis concludes that this amounted to an attempt by DHS to  
raise   its   rival’s   costs   and   hence   prevent   effective   competition   in   the   switching  
market.36
112.G:enesis goes into an analysis of this aspect in greater detail later,  
when responding to Magennis ‘s report, as we discuss below.
Response to G:enesis by Magennis
• In response to G:enesis, Magennis first  
deals with the analysis of the HB offer to  
DHS.   He   does   not   contest   G:enesis’  
thesis of the reasonableness of the offer  
vis a vis Med­e­Mass. Rather his point of  
departure   is   that   any   request   for  
integration   needs   to   be   assessed   from  
the perspective of the DHS group as a  
whole. He states in his response: 
“   it   would   be   inconceivable   that   the   group   shareholders   would  
permit a subsidiary to take decisions that benefit that subsidiary in  
the short term but that threaten the long term viability of the group  
as whole.”  37
113.Thus Magennis appears to concede that the HB offer is  
beneficial at least to Med­e­Mass. He goes on to argue  
that front­end access would create an asymmetry in the  
market   that   would   lead   to   foreclosure   effects,   unless  
DHS   gets   fair   and   unfettered   back­end   access.   38  He  
then   details   how   HB   could   successfully   implement   a  
foreclosure strategy against DHS. 
114.Magennis   then   examines   the   G:enesis   critique   of   the  
reasonableness   of   the   DHS   offer.   Magennis   observes  
that G:enesis attacks the DHS offer on three bases: 1)  
35  See Record, page 287 of the record
36  See Record. pages 1072­4
37  See Record, page 1163 .
38  See Record, page1166.
31

that the MediKredit agreement is out of line with market  
norms   2)   that   the   offer   to   HB   is   even   worse   than  
contained in the agreement with Medikredit, and 3 ) that  
the   fixed   R120   monthly   fee   proposed   by   DHS   to   HB  
translates into  45% of  switch  revenues per site and  is  
thus three times the pre­merger market norm of 15%. 39 
115.Magennis   does   not   deny   that   the   MediKredit   agreement   is   more  
favourable than the offer to HB and hence is discriminatory. However  
he defends the discrimination saying that as Medikredit has no back­
end connectivity: 
“..the   agreement   has   fewer   business   implications  
for DHS than a contract with HB would have”. 40
116.He then proceeds to defend the fact that the MediKredit  
agreement is not in line with what G:enesis contends is  
the   market   norm.   His   basis   for   doing   so   is   that  
MediKcredit is already a switch and accordingly should  
pay   more   for   access   than   a   company   which   is   not   a  
switch such as HAS. 41 He argues further that DHS cross­
subsidises Med­e­Mass. The risk of accommodating HB  
is even greater than that of MediKredit because of HB’s  
ability   to   foreclose   once   it   gains   front­end   access  
without granting back­end access. 42 
117.He   argues   that   Med­e­Mass   should   charge   a   premium   to   HB   that  
equates in its price to the risk such a contract would represent to the  
DHS group as a whole:
“In our opinion it would only be logical to reduce  
this   price   premium   if   and   once   the   risk   premium  
associated   with   the   back   end   access   is  
convincingly and comparably reduced.”   43
39  See Record, page 1174.
40  See Record, page 1174.
41  HAS was one of the firms whose contracts were relied upon by G:enesis in its analysis of the  
market norm for access agreements and hence the reference to it.
42  See Record, page 1176.
43  See Record pages 1176­7. 
32

118.He   goes   on   to   refer   to   his   initial   report   and   points   out   that   his  
computations were based  on actual  cost and revenues  pertaining  to  
DHS. As he put it :
“   they do not rely on a comparison with ‘ market  
norms’ as presented in the G:enesis report.” 44
119.Magennis does not dispute the 45% contention about  
the integration fee but again relies on the fact that if HB  
achieves greater roll­out the fee as a percentage of site  
transactions would reduce. 45
120.He goes on to criticise G:enesis’s methodology for not including in its  
calculations   the   fees   that   HB   is   likely   to   charge   DHS   for   back­end  
access. He says: 
“The value of these (unknown) fees should be set  
against the fees charged by Med­e­Mass for front  
end access.”  46
121.On the R120 000, he says that if it is true that HB will  
effectively secure 100% of the switching market once it  
gains unfettered front­end access (in the absence of a  
symmetrical   switching   agreement),   then   the   R120   000  
minimum fee will have no economic relevance. He then  
engages   in   some   ad   hoc  defence   of   the   R120   000,   by  
saying   that   the   proposal   allows   for   a   management  
committee, which would oversee the performance of the  
agreement.   He   says   that   both   parties   would   have   an  
interest   in   rolling   out   at   least   1000   sites   over   the   7­
month   period   designated   in   the   agreement,   including  
Med­e­Mass, because it would spread costs of additional  
staff   needed   for   the   roll­out.   He   says   that   it   is   his  
understanding   that   it   is   the   responsibility   of   HB   to  
approach doctors to convert to real­time connectivity. 
44  See Record page 1177.  
45  See Record, page1178
46  See Record, page 1179.
33

122.Magennis at first appears to justify the minimum R120  
000   and   R120   per   site   fee   as   Med­e­Mass’   way   of  
protecting itself against the cost of roll­out. He argues  
that roll­out is risky and hence Med­e­Mass is entitled to  
protect itself against this risk and pass it on to HB. He  
says that given that Med­e­Mass has to retain a national  
footprint, it is reasonable for it to engage in strategy that  
ensures that  there is a fixed  price if  it  cannot  be sure  
how quickly roll­out will take place.  47  Yet even here the  
cost   issue   is   always   linked   to   back­end   access.   After  
referring   to   the   fact   that   the   R120   is   similar   to  
MediKredit’s R117,50 he states: 
“   This calculation is relevant in a scenario where  
HB is placed in a position to eliminate DHSwitch.”  
48
123.Having   said   all   this,   however,   he   comes   back   with   a   devastating  
conclusion that if matters relating to back­end could be resolved: 
“it   is   reasonable   to   assume   that   the   DHS   group  
would be under less financial and commercial risk  
and therefore could afford to be more flexible in its  
pricing structure.”  49
G:enesis in reply 
124.G:enesis commences its response by looking at the issue of back­end  
access since this is a central plank of DHS’s case. It points out that  
although Magennis relies heavily on this as part of his critique of HB’s  
approach   he   does   not   consider   the   various   offers   that   HB   and  
Discovery made to DHS in respect of back­end access.
“This omission undermines the authority and persuasiveness of  
the Elixir report”  50
47   See Record, page1181.
48  See Record, page 1181.
49  See Record, page 1181.
50  See G:enesis response to the Elixir report dated 30 October 2003, page 6. 
34

125.G:enesis then goes on to argue that real­time back­end access, the  
supposed competitive advantage that DHS asserts HB has over it, is  
not   all   that   its   made   out   to   be.   After   considering   the   history   of  
successive claim­lodging technologies, of which real time is only the  
latest,   G:enesis   argues   that   real   time   has   not   proven   particularly  
advantageous to many doctors and is not a prerequisite to competing  
in the market. Thus although the real­time advantage is premised on  
the fact that the doctor is accessing the network as and when patients  
come in (i.e. many times a day) and secondly that it aids cash flow  
since the doctor is paid within 9 days (Discovery offers payment within  
24 hours if a real­time end­user is prepared to pay an additional 0.9%  
of the value of the claim for the expedited payment) and not 10 days  
later, as is the case with batch switches like DHS, G:enesis’ research  
of Medscheme’s records shows that 95% of end users claim once a  
day or less. On payment frequency it argues that for smaller practices  
the alleged 9­day advantage is negligible (For a practice with a R 60  
000 per month income this would amount to R 54 per month.)  51 
126.G:enesis then goes into much greater detail in arguing why the DHS offer was not  
reasonable. It argues 1) that the DHS offer contained a large post­merger increase in  
price, 2) that when compared to market norm it would foreclose a significant part of  
the market to HB and 3) that it would render the strategy of HB of universal roll­out as  
‘not achievable’ . 
127.Some   prefatory   remarks   are   needed   to   understand   this   roll­out  
argument and the statistics G:enesis seeks to rely on. It is common  
cause that not all practices are lucrative for switches. This is because  
certain practices generate such a low level of claims per month that  
they   fail   to   cover   the   switches’   fixed   costs   for   the   site.   Thus   the

they   fail   to   cover   the   switches’   fixed   costs   for   the   site.   Thus   the  
switches compete not for the whole market, but for the lucrative end of  
the market i.e. those practices that will generate the most claims and  
hence the most revenue for the switches, as their revenue is based on  
the number of claims made on their networks. 
128.From   the   perspective   of   a   PMA   supplier   or   at   least   based   on   the  
model in the offer of DHS to HB, the quality of revenue of the practice  
is   irrelevant   and   as   its   cost   is   a   fixed   one,   it   will   get   the   same   fee  
irrespective of how many claims a practice lodges. Thus Med­e­Mass  
on the DHS offer is protected in the roll­out from the ‘claims quality’ of  
the practice. 
129.From   the   perspective   of   HB’s   two   shareholders,   Medscheme   and  
Discovery, roll­out even to poor­quality practices is in their interests as  
the more practices that are on­line the less the administrators have to  
51  See G:enesis report dated  30 October 2003 page 15.
35

have their own staff and an infrastructure geared to dealing with the  
more expensive system of manual claims.
130.HB   and   DH   Switch   operate   on   different   revenue   models   for   their  
switching   businesses.   The   essence   of   the   difference   is   that   HB  
receives payment, partly from Medscheme or Discovery for each claim  
it   sends   to   them,   whilst   the   balance   comes   from   the   practice   that  
generated the claim. DHS derives its full fee from the practice, which  
has put it at a slight price disadvantage when compared to HB. (This  
has   fuelled   DHS’   notion   that   HB   is   subsidised   by   its   two   medical  
administrator shareholders.) Thus for switches the issue is not merely  
about roll­out, it is, to quote G:enesis, the difference between ‘cherry  
picking’ and ‘lemon picking’. 
131.G:enesis then goes on to perform an analysis of the implications of the DHS offer on  
HB’s potential for roll­out, by applying the fees set out in the DHS offer to a sample of  
Medscheme   practices   to   demonstrate   how   this   would   affect   HB’s   costs.   Its  
calculations   show   that   if   the   roll­out   was   just   to   the   top   50%   of   the   Medscheme  
practices (i.e. those that are the most profitable in terms of claims generated) HB’s  
costs would increase by   39%. If the roll­out were extended to all the Medscheme  
practices, HB would operate at loss. 52
132.G:enesis then argues that the cost implications of the DHS offer would  
be a possible increase in price by HB. G:enesis then does an exercise  
that compares the market norm for access (that it had referred to in its  
initial report) with the DHS offer. Under the market norm offer, 3400  
sites of Medscheme (52%) would be profitable, whilst under DHS’ offer  
only   1400   (21%)   would   be   profitable.   HB   has   acknowledged   to  
G:enesis that it does roll­out to sites that are not profitable for it on a

G:enesis that it does roll­out to sites that are not profitable for it on a  
fixed   cost   basis.   Approximately   23%   are   negative   in   this   respect.  
Although out of this 23%, 16% lose up to R20 per month, none have a  
pre­fixed cost loss of more than R20. Conversely, it argues that on the  
DHS  scenario,  4900   sites   would   have  a  pre­fixed   cost   loss   of  more  
than R20, as opposed to none presently.
133.G:enesis   also   maintains   that   the   DHS   offer   is   an   insuperable   barrier   to   entry   to  
switches that want to roll out to smaller practices. It argues that if roll­out started from  
the biggest sites it would be profitable up to 1400 th site, but thereafter becomes less  
profitable until it runs at a loss for HB from the 4600 th site onwards, assuming a total  
roll­out would be up to 6500 sites. Servicing the entire market would mean that HB  
would lose R230 000 per month. Applying the market norm, however, rolling out to all  
6500   sites   would   mean   that   HB   could   still   generate   a   profit,   albeit   lower   than  
otherwise.53
134.G:enesis goes on to analyse the fixed payment model vs. its own and suggests that it  
52  See G:enesis report of 30October 2003 page 20.
53   Genesis calculates that it would generate R 407 000 which say is only 30 000 less than its  
maximum profit. See Magennis Report of 30 October 2003 page 27. 
36

offers no incentive for Med­e­Mass to roll­out to high value sites.  54 It points out that  
since DHS owns its own switch DHS is incentivised to roll out to lower as opposed to  
high revenue sites. Thus over a 36­month period HB could be left with only loss­
making sites.
135.Figure 5 of  the report  illustrates the “long  tail” of  unprofitable sites.  
G:enesis goes so far as to suggest that DHS was “astute” in its offer as  
a no­lose situation for DHS. If the offer were rejected then HB would be  
denied access to the front end; if the offer were accepted it would raise  
HB’s costs relative to those of its rivals. 55
136.G:enesis also deals with who will give effect to the roll­out: the PMA  
supplier or the switch. Recall that Magennis had said that it was for HB  
to persuade practices of the advantages of real  time. G:enesis says  
that it may be that HB has to persuade doctors to ask for conversion,  
but DHS is still responsible for its implementation. G:enesis points out  
that in terms of the contract DHS undertakes to rollout 420 sites within  
7 months. 
137.The upshot of this analysis is that Genesis concludes that the DHS  
offer raises HB’s costs and for this reason is unreasonable.
138.G:enesis   also   goes   on   to   defend   the   reasonableness   of   HB’s   and  
Discovery’s back­end offer to DHS. As will appear later in this decision  
this is not an issue that we have to consider.
Analysis of the expert testimony 
139.There   is   no   serious   dispute   of   fact   among   the   experts.   What   the  
experts disagree upon is how the concept of reasonableness should be  
analysed. 
140.Magennis assesses the notion of reasonableness, as we have seen,  
from the affect it has on the business of DHS as a whole in the market  
in relation to HB and concludes that if DHS gives up front­end access  
without   securing   back­end   access,   the   business   of   DHS   will   be  
adversely affected as it will lose all or part of its switching business to

adversely affected as it will lose all or part of its switching business to  
HB, because of the latter’s real­time advantage.
141.Let   us   assume   for   the   moment   that   we   accept   the   evidence   of   Mr  
Magennis in this respect. Could this be what the Commission’s order  
means   when   it   refers   to   a   reasonable   access   agreement   and   in  
particular commercially reasonable terms?
54  Note that in its offer, HB offered DHS a roll­out incentive for all sites that would generate more  
than R350 per month. See Record page 1062.
55  See Magennis Report of 30 October 2003 page 26.
37

142.Against   this   we   have   the   interpretation   advanced   by   HB   and   the  
Commission.   According   to   them   DHS   enjoys,   post   merger,   market  
power over the switching segment of the market. It has achieved this  
through   the   vertical   integration   of   the   dominant   PMA   firm   with   a  
significant switch player, which post­merger would allow it to foreclose  
its rivals in the switching market. On the evidence before us the only  
competitor of significance is HB. For HB and the Commission the real  
but unstated basis of the Magennis argument is that it is unreasonable  
for DHS to contract on terms with its rival that do not compensate it for  
loss of its market power (euphemistically referred to as its competitive  
advantage). Thus they argue that what DHS wants to be compensated  
for under the mantle of reasonableness is really compensation for loss  
of its market power. This, they argue, cannot be a proper interpretation  
of the conditions.
143.We are persuaded by this analysis of the Commission and HB. The  
purpose   of   the   access   remedy,   as   the   Commission   explains   in   its  
merger   decision,   is   to   ensure   that   the   switching   market   remains  
competitive after the merger. In other words, in return for approving a  
merger,   which   would   lessen   competition,   the   Commission   seeks   to  
retain   pre­merger   levels   of   competition   by   ensuring   access   to   the  
PMAs   of   DHS.   Implicit   in   this   formulation   is   the   assumption   that   by  
permitting   access,   DHS   will   be   forced   to   face   competition   and  
accordingly be unable to exercise post­merger market power over the  
switching market. 
144.It follows, once one appreciates the economic consequences of what access means  
(when   posited,   as   the   Commission   explains   in   its   report,   as   the   antidote   to   the  
exercise of market power) that the firm that acquired market power and was now to

exercise of market power) that the firm that acquired market power and was now to  
be inhibited from exercising it by granting access, would be worse off – at least to the  
extent that its market power premium would be forgone. It makes no sense for the  
Commission to impose a condition that would allow access only on condition that the  
merged firm is compensated for its loss of market power. Yet that is precisely the  
implication   of   the   case   that   DHS   has   made.   Whilst   such   an   interpretation   of   the  
conditions   may   have   been   plausible   were   this   an   arbitration   assessing   damages  
arising from a breach of a commercial contract, it is nonsensical in the context that we  
are dealing with here – an order by a body charged with protecting competition, which  
as part of this function can regulate the approval of mergers  inter alia  to prevent the  
exercise post merger of market power by the merged firm.
145.When   the   peculiar   language   of   the   conditions   is   assessed   in   this  
statutory   context,   and   when   they   are   read   with   the   Commission’s  
reasons for its approval of the merger, the concept of reasonableness  
contended for by DHS becomes untenable.  
146.In adopting this approach to the interpretation of the conditions we are following an  
approach   that   is   well   settled   in   case   law   and   which   has   been   followed   by   us  
previously. That is one set out in decisions such as  Administrator, Cape, and Another  
38

v Ntswaqela and Others (1) 1990 (SA) 705 at 715 E­I, and Firestone South Africa  
(Pty) Ltd v Genticuro 1977 (4) SA 298 (A) and The ANC v The UDM and Others  
Constitutional Court of South Africa, Case No: CCT 43/02 .56 
147.If   we   interpret   the   conditions   in   a   manner   consistent   with   the  
Commission’s reasons for its decision then it is perfectly clear what it  
intended.   Firstly   the   sentence   that   serves   as   a   preamble   to   the  
conditions states:
“However, the Commission is of the view that the conditions set out below would  
significantly reduce those concerns. The merger is, therefore, approved, subject to the  
following conditions…”  
148.Thus   the   Commission   makes   it   clear   that   the   conditions   serve   to  
remedy the anticompetitive effects that it finds will come about as result  
of the merger. Given this intent, it seems that the Commission saw the  
grant of access as vital to remedy this problem. It is unlikely that the  
Commission would easily have contemplated a situation where access  
did not occur, since access was the cure or partial cure to the ill it saw.  
If   access   did   not   occur,   the   merger   would   proceed   as   if   approved  
unconditionally. 
149.However, the Commission could also foresee that a firm required to  
give access is not obliged to do so without some compensation. The  
Commission   seemed   to   recognise   one   could   cure   the   competition  
concern without on the other hand making the merged firm vulnerable  
to some competitor who required access at say sub­market terms. This  
would go beyond the Commission’s intention of ensuring competition in  
the switching market and lead to the opportunity for exploitation of the  
merged firm. 
150.In this regard we agree with HB that this is the meaning to be given to  
the reasonableness terms i.e. the merged firm was not obliged to enter  
into an agreement for access that was not in accordance with market

into an agreement for access that was not in accordance with market  
norms for such access or did not adequately compensate an efficient  
firm for the costs of granting such access. It does not follow that this  
allowed the merged firm to seek compensation at a supra­market price  
or to  impose terms that  are  unrelated  to the access agreement and  
which   may   render   it   less   likely   to   lose   its   market   power.   The  
exploitation of the merged firm that the Commission sought to protect  
by   the   caveat   of   reasonableness   in   its   order   did   not   extend   to  
compensation   for   losses   in   the   switching   market   that   access   by   a  
competitor   might   occasion.   This   would   amount   to   interpreting   the  
condition   as   if   the   Commission   desired   only   the   appearance   of  
56  Also see Tribunal case, Astral Foods Ltd v Competition Commission and others, Case No: 69/AM/
Dec01.  
39

competition, but not its reality.
151.The experts for HB are correct when they state that the entire purpose of the remedy  
was to create a competitive situation in the switching  market.  It  is consistent  with  
these conditions, and indeed access conditions in general, that in consequence the  
firm granting access may find its market position eroded ­ that is unless it reacts by  
competing more vigorously. What DHS regards as a perverse outcome of the reading  
of the order by HB is in fact the situation that the order contemplates. This is the  
raison d’  être for the condition. 
152.We   find   that   DHS’   interpretation   of   the   conditions   is   incorrect,   and  
accept   the   version   of   the   Commission   and   HB,   namely   that  
‘reasonableness’   meant   that   the   access   terms   should   not   be  
exploitative of the merged firm, in the sense we have explained above.  
Indeed, there is an equally plausible third reading of ‘reasonableness’  
which is not  inconsistent  with this  one above,  and that  is that if  the  
merged firm gave access on terms that perpetuated its market power ­  
the suggestion made by MediKredit in  relation to its agreement  with  
DHS   ­   those   terms   would   be   unreasonable.   In   other   words,  
reasonableness,   which   every   one   has   contended   had   to   be   read   to  
benefit   the   merged   firm,   might   have   been   meant   to   protect   the  
competitive process from abuse. Nevertheless, we need not find that  
this latter interpretation is the correct one or the only correct one. It  
suffices for us to reject the interpretation of DHS and to accept that of  
the Commission and HB as the more plausible.
153.Having come to this conclusion on the interpretation, we find on the  
facts   that   HB   has   established   that   its   original   offer   was   reasonable.  
Firstly,   in   terms   of   its   consistency   with   market   norms,   even   being

Firstly,   in   terms   of   its   consistency   with   market   norms,   even   being  
conservative   in   this   regard.   Secondly,   and   this   appears   to   be  
uncontested,   it   was   reasonable   in   the   sense   that   it   adequately  
compensated   Med­e­Mass   for   the   costs   of   access.   It   was   not  
necessary for the offer to compensate DHS for its loss of its switching  
business, assuming, accepting Magennis, that this might have been a  
consequence of the agreement.
154.It   is   of   course   not   sufficient   for   us   to   find   that   HB’s   offer   was  
reasonable. We must also find DHS’ responding offer unreasonable. In  
this respect we find that HB’s experts have made out a case for this  
offer not only being less favourable to HB than the market norm, but  
also likely to raise its costs of doing business. Again, this evidence is  
not seriously contradicted, and DHS‘ riposte, that compensation for the  
loss of market power justifies these terms, has already been rejected  
by us as a proper approach to interpreting the conditions. Since that  
was the only basis on which DHS sought to defend the reasonableness  
of its offer, it too must fail, and the offer is considered unreasonable.
155.It follows then that DHS’ insistence on back­end access was an issue  
40

extraneous to the proper interpretation of the order and a device for  
DHS   to   compensate   itself   not   for   the   reasonable   costs   of   granting  
access to the PMA market, but a loss of market power or the potential  
to exercise that power in the switching market. 
The non­conclusion of an agreement
156.DHS says in par 12.8 of its heads of argument, dated 13 September 2003, that it is  
clear   from   the   Commission’s   notice   that   the   non­conclusion   of   the   agreement  
triggered the CC19 notice and not whether there was substantial compliance with the  
merger obligations. This failure by the Commission to apply its mind should by itself  
lead to a review in terms of rule 39(2)(b), as well as in terms of s 6(2)(e)(ii) and s 6(2)
(f)(ii) of the Promotion of Administration Justice Act 3 of 2000. 57
157.However, we need not address this issue since this argument was addressed in great  
detail as an   in limine   point in the first part of our decision where we found it to be  
without merit.  58 
Hacking 
158.DHS   argued   as   an   independent   and   self­standing   reason   for   the  
denial of access, that HB had allegedly sought to achieve access to its  
PMA software by hacking. 
159.Again we do not need to go into the record on this issue, which is  
lengthy, acrimonious and disputed by HB. Indeed, in fairness to HB, we  
must record that it denies the allegations strenuously and points out  
that a High Court application for an interdict was withdrawn after HB  
filed its answering affidavit. To add another twist to the tale it appears  
that the proceeding is to be renewed by DHS in another form.
160.We are certainly in no position to determine if hacking occurred. What we must ask is,  
if DHS  bona fide  believed that hacking took place, did this justify it not entering into  
an   agreement   with   HB?   In   our   view   it   did   not.   Mr   Burger   correctly   conceded   in  
argument that the hacking issue did not relate to whether HB was a flawed person

argument that the hacking issue did not relate to whether HB was a flawed person  
and   thus   an   undesirable   party   to   contract   with.   Rather   he   pinned   his   colours   to  
hacking being a reason for not reaching a timely agreement. This argument does not  
make sense on the record. It is quite clear from the correspondence that after the  
allegations   of   hacking   were   first   aired   in   August   2001   t he   parties   continued   to  
negotiate.59  Indeed, the existence of DHS’ April 2002 offer premised on back­end  
access   indicates   that   it   was   this   issue,   not   hacking,   that   was   foremost   in   DHS’  
consideration about negotiating access. Hacking appears to have become a  post hoc  
rationale to justify DHS’ failure to grant access and to serve as another arrow in its  
quiver of defences should the others fail.
57  This aspect is also addressed as an  in limine  point in the first part of our decision .
58  See page 11 of this decision.
59  See page 82 of the record.
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Conclusion 
161.In our view the applicant has failed to establish that it has substantially  
complied with the obligations contained in the conditional approval of  
the merger.
162.In the first place it refused to enter into an agreement proposed by HB  
on reasonable terms.
163.Secondly, the terms on which it was prepared to grant access were  
unreasonable   both   in   relation   to   its   offer   of   June   2001   and   its  
subsequent demand to make access conditional on back­end access.  
Thirdly,   the   linking  of   the   refusal   to   the  alleged  hacking   was   on  the  
facts before us an extraneous issue that did not reasonably constitute a  
ground for not agreeing to access.
164.The application therefore fails. 
Costs
165.HB is awarded the costs of the application on a party and party basis including the  
costs of three legal representatives. No costs are awarded to the Commission as we  
have not yet heard any argument to persuade us against our present understanding  
of   our   powers   which   is   that   we   can   neither   award   costs   for   or   against   the  
Commission.60 Had the situation been otherwise the Commission would have been  
entitled to costs.
166.For the same reason no costs are awarded against the Competition  
Commission in respect of the withdrawal of the application to file a late  
expert report.
  4 February 2004
N. Manoim   Date
Concurring: L Reyburn 
60  See our decision in Commission v SAA, Case No: 18/CR/Mar01
42