Rescue plan for controversial medical guideline tariffs

By Staff Writer
In its quest to find common ground with a medical profession fiercely opposed to the regulation of medical practitioner fees, the Health Professions Council of South Africa (HPCSA) recently appointed healthcare actuary, Shivani Ramjee, to assist with the process of setting a guideline tariff that can be used to assess overcharging by medical practitioners.
 
Earlier this year the HPCSA extended the deadline for submissions to determine guideline tariffs for medical and dental services to 21 February 2013. 
Ramjee, a member of the Actuarial Society of South Africa and head of actuarial science at the University of Cape Town (UCT), said the absence of guideline tariffs for medical and dental practitioners created a problematic vacuum that left consumers unable to prove whether medical practitioners were overcharging them.
 
Previous attempts to impose guideline tariffs
 
According to Dr. Rajesh Patel, head of benefit and risk at the Board of Healthcare Funders, some members of the medical profession are opposed to the new guideline tariffs as they would no longer be able to exploit the situation by overcharging consumers.
Up to now if a medical practitioner is accused of overcharging their patients, the onus is on them to justify their fees.
 
The Health Professions Act does make provision for the establishment of a mechanism by which the HPCSA can determine whether a medical practitioner overcharged a patient by means of a “price norm” but this has yet to materialise. 
 
A previous attempt to introduce guideline tariffs was aborted last year after medical associations threatened legal action. The HPCSA was accused of having set guideline tariffs that were unreasonably low and calculated without scientific basis. With the help of a healthcare actuary, the HPCSA plans to make sure that future price norms will have a strong scientific basis.
Patel said that as Ramjee is an external consultant it would ensure that the process is without any political bias and beyond reproach.
 
“Since the setting of a norm will have financial implications for health professionals, funders and the general public this process needs to be fair, rational and lawful. Guideline tariffs must protect the right of medical practitioners to earn a fair living and recognise the fact that their skills are scarce. A pricing norm must also ensure the sustainability of private practice and ensure that the profession remains attractive to new entrants. Consumers, on the other hand, are entitled to fair and reasonable fees. Equally important is that patients are empowered to give informed consent based on transparent pricing structures,” said Ramjee.
 
What will the guidelines mean to the consumer?
 
Patel said that although the regulated tariffs are a step in the right direction, consumers need more certainty.
“There will be more transparency than before but what our country needs is a stipulated maximum regulation fee which would mean doctors can charge no more than a certain amount,” said Patel.

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