BHF statement on the recent HPCSA statements on DSP contracting

Statement by the Board of Healthcare Funders of Southern Africa (BHF) on recent statements made by the Health Professions Council of South Africa (HPCSA) on DSP contracting

The BHF is extremely concerned at the comments made recently by the Health Professions Council of South Africa. The HPCSA recently released a statement to the effect that healthcare practitioners should be cautious when concluding designated service provider (DSP) agreements with medical aid schemes as the medical aids attempted to reduce costs by applying pressure on practitioners within a DSP network to prescribe medication or recommend treatment options, when other more appropriate, albeit more expensive, options were medically indicated and readily available.

The BHF’s view is that this undermines the legislation which allows for DSP contracting. In the current environment where there are no regulated tariffs for healthcare procedures and runaway increases in healthcare costs, the ability for medical to contract with DSPs is one of the only ‘tools’ which medical schemes have to bring about some kind of certainty in the charges by healthcare providers. Without this, medical schemes would lose one of the most important mechanisms for containing costs for their members.

Medical scheme formularies (the list of medicines covered by schemes) are compiled in consultation with healthcare practitioners in order to manage efficiency and to ensure that the healthcare rand is optimally spent. The formulary does not dictate what a doctor may prescribe but is a guide as to what will be covered by the scheme.

It is the BHF’s view that over-servicing, rather than under-servicing is far more prevalent in the private healthcare industry. Thus, the cautionary offered by Regulation 7(3) of the Ethical Rules of Conduct for practitioners registered under the Health Professions Act of 1974 is extremely pertinent.

This legislation states that practitioners “shall not offer or accept any payment, benefit or material consideration which is calculated to induce him or her to act or not to act in a particular way not scientifically, professionally or medically indicated or to under-service, over-service or over-charge patients”.

The BHF believes that the HPCSA and the CMS should engage to find a solution to the HPCSA’s concerns.