Is plan for uniform tariffs a real threat to SA's medical profession?
Private practitioners’ forum says a pricing guideline must be based on the cost of running a practice
Health Minister Aaron Motsoaledi’s plans for a uniform tariff for healthcare services may prompt doctors to quit the profession or seek jobs overseas.
The minister said last week the Medical Schemes Amendment Bill, which he presented to a cabinet committee last Tuesday, contained proposals that would introduce a uniform tariff for healthcare providers and put an end to copayments.
The intention was to provide greater certainty for consumers and medical schemes, he said.
At present there are no regulations governing the rates that doctors, hospitals and other healthcare providers charge.
This means that two patients who receive identical services may receive different bills and face different out-of-pocket expenses depending on the bargaining power of the medical scheme they belong to, and the rules of the option they choose.
If they are presented with a bill for a consultation or procedure that is more than the scheme is willing to pay, they will be liable for the balance.
Leeway for doctors
The South African Private Practitioners Forum, which represents doctors in private practice, said it was not opposed to a tariff guideline provided it was based on the cost of running a practice. However, doctors should be permitted to charge higher rates if they had good reason to do so, said forum CEO Chris Archer.
"What are they going to use to inform the process [of determining tariffs]? If it is just a thumb-suck, it will cause untold damage to the private sector and a lot of young doctors will be forced into some other form of enterprise or to emigrate. You cannot provide a service below cost," Archer said.
"If the minister is trying to reduce the cost of care, he needs to look at utilisation. That is pushing up the cost, not the unit cost of providers," he said.
The pricing free-for-all in the private healthcare sector is partly due to a decision by the Competition Commission in 2003 that banned collective bargaining between medical schemes and service providers.
It stopped the representative body for medical schemes, the Board of Healthcare Funders, from negotiating prices with provider groups such as the Hospital Association of South Africa, which represents private hospitals, and the South African Medical Association, which represents doctors.
Price list guide
The health department then tried to establish a national health reference price list to guide the industry, but the process foundered after the High Court in Pretoria found in 2010 its process for calculating the rates was flawed and bore no relationship to the costs of running a practice.
It was unfortunate that the reference price list was done away with, said South African Medical Association chairman Mzukisi Grootboom.
"It has led to some of the problems we are seeing where people charge what they like without reference to medical scheme affordability," Grootboom said.
A tariff guideline determined by an independent body would be welcome, but if it capped the rate a doctor could charge, "people will refuse to be part of the arrangement … and others may decide to leave and work somewhere else," he said.
Board of Healthcare Funders head of risk and benefits Rajesh Patel said the organisation was encouraged to see that many of the issues it had raised were potentially being tackled in the bill.
The minimum benefits contained in the bill, which all medical schemes would be obliged to cover in full, should have a price ceiling to provide certainty to schemes, Patel said.
Otherwise schemes would face an open-ended liability for these benefits, he said.