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It is wrong to say doctors hike the tariffs for PMBs

I refer to an article written by Londiwe Buthelezi (Business Report, November 29), regarding medical schemes complying with the provisions of the Medical Schemes Act (131 of 1998), especially those in respect of fees payable for prescribed minimum benefits (PMBs). I refer you to chapter 3, paragraph 8, section 2, where it stipulates that any benefit offered by a medical scheme must reimburse in full without co-payment or the use of deductibles, the diagnostic treatment and care cost of PMB conditions specified in Annexure A.

I perform an accounting function for a specialist plastic and reconstructive surgeon. The nature of his practice is such that he reacts to trauma such as motor vehicle accidents, accidents in the workplace and at the home and such like, requiring emergency surgery. He is also required to excise lesions, often of a malignant nature.

Both these examples are defined as PMBs in terms of the regulations.

I wish to consider two matters. First, I wish to respond to the comment by the chief executive of the Board of Healthcare Funders of Southern Africa (BHF), Humphrey Zokufa. He said: “What this enforcement (by the Council for Medical Schemes) does, is enrich the providers at the expense of the consumers.” Others have called it “a free for all” environment.

These statements clearly imply that doctors load their accounts freely if the condition can be claimed as a PMB.

The statements are disingenuous, as those making them well know. Health professionals set their tariff rates once a year or so (as any business does to cope with inflation), which are open to scrutiny at any time. These tariffs apply to all their patients.

If any “load their tariffs” above their own tariff structure, simply because the procedure was defined as a PMB, that professional would be guilty of unethical conduct and thus be subjected to a disciplinary hearing. I challenge those making these insulting statements to name any professional so guilty and charge him or her with unethical conduct – we would welcome it.

An excellent paper presented recently by professor Robert Dunn, entitled “Ethics of billing – determining one’s value”, proves that professional fees charged by an average practice resulted in take home pay of in fact marginally less than the take home pay of a similar professional in the public sector.

This took into account that the private sector practitioner paid for the overheads of his rooms and his staff, as well as VAT, and he had to carry a bad debt book of over 20 percent of turnover. All of this is covered by the state for the public sector doctor.

And yet the medical schemes attempt to force doctors to accept what amounts to a third of these tariffs.

Second, I submit that medical schemes are insurance companies specialising in medical cover. As for all insurance companies, they employ actuaries who assess risk per client and charge premiums accordingly. Their risk is thus measurable and should be covered.

The government has interfered in that risk factor with PMB regulations, but insists that the schemes carry a PMB risk fund equal to at least 25 percent of tariff income to offset that risk. The PMB insistence, by government regulation, is there to offset the government’s own risk in case it may have to deal with the burden of PMB diagnoses.

The sole purpose of prescribed minimum benefits is to assist patients who find themselves in dire straits resulting from the specified diseases and emergency conditions. It is not there to make doctors fat.

Frank van der Velde

Cape Town

Pick n Pay, Saccawu deal is a chink of light

The article headlined “Union agreement saves 2 000 jobs at Pick n Pay” (Business Report, December 2) refers.

We, the general public, need to applaud the SA Commercial, Catering and Allied Workers’ Union and Pick n Pay for their ability to think beyond the win-lose fight that occurs every time companies are restructuring and changing operational requirements. Our country is no different to the rest of the world and our economy has been squeezed from every angle.

Minister Trevor Manuel, in his structured planning, has called for the development of atypical employment. Minister of Finance Pravin Gordhan called for the relaxation of labour laws and President Jacob Zuma has called for the creation of 5 million jobs. These calls mean that it cannot be business as usual. We are starting to see glimmers of hope when the textile industry agrees on a 30 percent cut of entry wages, and we now witness an incredibly innovative agreement entered into between Pick n Pay and its union.

Maybe there is still some hope and maybe this type of agreement will show the way forward to the rest of the industry. Pick n Pay has, for the time being, avoided a mass retrenchment and this will mean a saving of over 2 000 jobs and relief for over 10 000 people.

The increased flexibility allowed at the workplace will mean better service to the public and, in particular, might save jobs in other enterprises.

MICHAEL BAGRAIM

CAPE TOWN

Anonymous writer is misleading readers

A column, named “Temperature rising”, written under the nom de plume of A Green was featured in Business Report, November 23.

It is a long time since I read such an insulting, patronising, inaccurate article. The readership of Business Report is assumed to be of above average intelligence, but A Green sneers at readers and treats them as uninformed kindergarteners. He or she said: “Now I know how the Old Testament prophets felt with their flocks: completely crazy with frustration and helplessness. Wake up people. Wake up. Lets hope the Celestial Bridegroom cometh to save those with their little oil lamps trimmed…”. He/she added: “Politicians do not appear to be able to think much beyond five years, if at all.”

Having insulted the intellect of readers, he/she then went on to say “…the continuous burning of fossil fuels in pursuit of the unsustainably luxurious lifestyles is causing escalating global warming...”.

I would like to point out that the reason we want more electricity in Africa is because millions of children have to do their homework by candlelight, many schools and rural clinics have little or no electricity, the list goes on. He/she should tell them to forget any dream of electrification.

The hottest year in recent decades has been 1998. Since then, there has been no temperature increase, and in fact a bit of cooling has set in.

He/she uses the dishonest trick of saying: “The hottest temperatures ever recorded have been in the past 12 years…” Note, 12 years ago is 1998. He/she cunningly omits to mention that temperatures are now coming down, in direct contradiction to the CO2 warming theory.

He/she then makes the staggering claim that sea level will rise 20m for every 1ºC rise in global temperature. Yes 20m, or the height of a three to four storey building. He/she then manages to escalate that to “at least 60m higher than today”, with no time scale attached. In fact, even the Intergovernmental Panel on Climate Change itself, which is not the most credible of sources, only estimates an average sea level rise of 35cm over the next century.

He/she then goes on to excel himself/herself and we get the ridiculous comment that Pakistan hit 54.5ºC this summer; “That’s more than halfway to the boiling point of water”, the open mouthed readers are told. In fact at Al’Aziziyah in Libya the temperature hit 57.7ºC in 1922 and hit 50.3ºC at Kirkwood in the Sundays River Valley in the Cape back in 1928.

The manipulation that A Green tries to pull on the readers is the worst form of approach to the COP17 UN climate talks. Let us rather use correct science and find out the truth.

Dr Kelvin Kemm

nuclear physicist, Pretoria

Cancel the arms deal, build a Joule factory

In this season of green endeavours, it is worth noting that Minister of Science and Technology Naledi Pandor said R9 billion needed to be found in order to turn Africa’s first electric car project, Optimal Energy’s Joule, from a research and development effort into a functioning production line in East London.

It is well documented that the people of East London are fully capable of assembling motor cars. Indeed, the independent JD Powers rating agency indicated recently that the Mercedes-Benz C-Class sedans made in East London and exported to the very fussy US market were the new cars about which consumers had the fewest complaints.

This is a feather in the cap of South Africa’s labour force in the motor manufacturing sector and an indication that the home-grown electric car could be more than just a pipe dream. The East Londoners have a “can do” attitude which is unfortunately not yet matched by the government on the funding side. It is not as though the entire investment has to come from public funds.

If the government shows sufficient confidence in the Joule to put in R3 billion, the market will surely match this with R3bn of its own, in which event the banks will feel sufficiently encouraged to lend the balance of the funding required to set up the plant and turn the Joule into a production model instead of highly impressive prototypes.

Alternatively, if the government wants to go it alone, it can cancel the BAE/Saab arms deal on the grounds that it is tainted by fraud and corruption, which has been admitted by the Swedes and also by the British. Give back the pretty useless jets and recover around R35bn from the arms dealers involved. This will provide more than enough of a windfall to finance the production of the Joule and a few more job-creating enterprises. The Joule project alone can create 10 000 new jobs and it is greener than the greenest green.

Paul Hoffman, SC

Director, Institute for Accountability in Southern Africa

Immigration officers not very rainbow like

On my fairly frequent overseas business trips it’s always good to get back to South Africa – but wouldn’t it be wonderful if the complement of immigration officers at our airports could reflect the multicultural nature of our society?

At the present time, they all appear to be sourced from the one ethnic background – hardly what Nelson Mandela promised us as a Rainbow Nation.

Come on, Home Affairs – isn’t it time for some transformation?

Edward Mitchell

Newlands, Pretoria

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