Londiwe Buthelezi
The Health Professions Council of SA (HPCSA) intends to introduce a temporary tariff guideline for specialist doctors as its absence has seen some charging up to 700 percent above what medical schemes reimburse.
Doctors and specialists have been operating without a set tariff since 2010, when the court declared the National Health Reference Price List (NHRPL) used by medical schemes invalid for use by health professionals.
When the NHRPL was in place, doctors charged up to 300 percent above the price the medical aids reimbursed.
The NHRPL falls under the Medical Schemes Act and before health professionals adopted it in 2007, many specialists and doctors charged 100 percent medical aid tariffs.
Sam Mokgokong, the president of HPCSA, said before the doctors leaned towards the NHRPL, they were not well-paid and were seen by their US and British peers as “working for charity”.
“When the NHRPL was adopted, most doctors then targeted the 300 percent mark. But now there is no reference price list… so anything goes. That’s when the concept of ethical tariff came about,” he said.
Now in the absence of a published tariff, the HPCSA was unable to adjudicate on complaints of overcharging.
The biggest problem with the absence of a tariff table was that patients were often not told how much more doctors would be charging above the medical scheme tariffs and they were taken by surprise on receiving the bill.
“The problem is (the patients) are often not informed that the doctors are charging that much above scheme rates,” Mokgokong said.
He said the HPCSA wanted the ethical tariff system to be done away with and the executive committee of the tariff board was due to meet yesterday to discuss a temporary guideline tariff until a permanent solution could be found.
However, the proposals of the board would first have to go through the council before being made public.
Rajesh Patel, the head of benefit and risk at the Board of Healthcare Funders, said about 2 percent of specialists had taken advantage of the no-tariff environment and increased their prices to between 500 percent and 700 percent above medical aid tariffs. The majority, about 80 percent, were charging 300 percent more.
“The reason why specialists costs have exploded so much is because in 2000, less than 15 percent of specialists were charging 300 percent. Now 80 to 90 percent are charging 300 percent above,” Patel said.
The HPCSA said as the cost of doctors continued to surge, the general practitioners were not getting what they were entitled to. According to the Council for Medical Schemes 2011 figures, they received R6.2 billion of the total R84bn of medical schemes’ expenditure.