A written judgement in the matter between BHF & SAMWUMED and CMS, Minister of Health, SAPPF, PSSA, USAP, Medi-Clinic, HASA, ER24 EMS, National Renal Care, Pharmaplan, B Braun Ativum, MSSA & SAMA was handed down this morning.
The BHF is disappointed that the merits and principles of the matter appear not to have been considered by Judge Pretorius.
Essentially, Judge Pretorius, in her judgement, has upheld the points in limine, and dismissed the case on the basis that BHF, as an industry body and therefore not directly affected by the outcome, lacks locus standi.
Whilst BHF will consider its legal options in this regard, we are concerned that the status quo will remain and believe that this is bad news for consumers, as the uncertainty with regards to pricing of healthcare will be allowed to continue.
We believe that this judgement may negatively affect the sustainability of medical schemes, which have been under severe financial pressure due to the opportunistic and reckless charging by some healthcare providers for Prescribed Minimum Benefits. We are concerned that medical scheme members will be negatively affected as their schemes will continue to be subjected to an open ended liability and may have no choice but to raise contribution premiums.
Over the past few years, the healthcare provider fraternity has been partly or fully responsible for the scrapping of all healthcare pricing guidelines and undermining the coding structure, thereby increasing costs within the private healthcare sector. We believe that the judgement will allow this untenable situation to continue.
The Minister of Health has cited spiraling costs in the private sector as one of the reasons to usher in NHI. Therefore, this judgement and the current behavior by some providers is simply reinforcing the need to regulate costs relating to healthcare services. The current unruly nature of charging for healthcare is undermining the reforms being proposed by government to make healthcare more accessible, equitable and affordable.
The BHF will engage the Minister of Health on the matter and urge that government steps in to assist the private funding sector to contain costs related to healthcare services.
The BHF will also urge government to establish the proposed Pricing Negotiating Forum so that the tariffs which are paid are fair and reasonable both to the provider and the medical scheme member.
We believe that the judgement could have paved the way for NHI in initiating a shift of mindset from having no limits on charges to a situation where providers and funders will have to agree on charges to protect the consumer.