Guiding consumers since 2009

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.

Recent Articles

Featured These factors will fluctuate your car insurance excess

When you take out car insurance, your monthly premium is a given. However, you may also need to pay an excess amount if you claim from your policy. But which factors may increase your excess, and how can you bring it down?

Is income protection available to everyone?

If you’re involved in an accident and you’re unable to continue working, how will you ensure that your bills are paid? One way to prepare for this is to take out income protection cover. However, can you do this if you’re a freelancer?

Aligning your financial goals in a relationship

When two people enter into a partnership through dating, marriage, co-habiting, etc, usually theres an enormous amount of effort spent on finding commonalities. However, this process often neglects the financial status and long term goals of each member.

How will your personal information be protected by your insurers?

POPI forces industries to reconsider how they handle client’s personal details. This is particularly good news for sensitive products, such as insurance.  We find out what POPI is all about, and we see how your information will be protected.

Deals

Bakwena Day Spa Black Friday Vouchers

Price: From R549
When: Until 27 November 2020
Where: Broederstroom, Centurion, Kuils River

One & Only Hotel Complimentary Nights

Price: Available on request
When: Until 17 December 2020
Where: Cape Town

Spur’s Unreal Breakfast Special

Price: R39.90
When: Daily
Where: Nationwide


Latest Guide

Guide to debt rehabilitation solutions