The published OMAC (Old Mutual Actuaries and Consultants) Healthcare Monitor, which evaluates the public’s perceptions of medical schemes’ products and services, highlighted a resistance to schemes’ use of designated service providers (DSPs). According to the report, ‘the reaction to the concept of DSPs is generally more negative than positive, owing mainly to resistance to rules that restrict freedom of member choice regarding service providers,’ especially in the case of GPs where contact is most frequent and a relationship is most likely to be established.
“While we understand that certain members may resent not being able to consult their doctor of choice, a scheme’s use of a DSP network plays an important role in keeping medical rates affordable, in addition to having a number of other advantages,” says Dr James Arens, Clinical Operations Executive at Pro Sano Medical Scheme. “I therefore encourage members not to rush to judgement in this regard. The OMAC report does also underscore that ‘members who currently use DSPs are more favourably disposed to them than those who are not’, recognising their role in keeping healthcare more affordable.”
DSPs are preferred providers with whom schemes pre-negotiate substantial discounts on behalf of their members. DSPs can be a group of GPs or specialists, or a hospital or pharmacy group. Using their services helps members to maximise their benefits.
The DSPs are of great value to both members and the scheme. To the patients’ advantage, the DSPs are approved by the scheme as practicing evidence-based medicine of a high standard. “Our chosen doctors adhere to the best clinical guidelines, especially when it comes to treating chronic conditions and reducing potentially avoidable hospital admissions,” says Dr Arens. “Tariffs are determined up front and members are therefore almost never liable for additional fees or co-payments. This means that members’ savings account will last longer and also translates into lower annual premium increases.”
In the case of GP DSPs, these doctors fully cooperate with the scheme and are at will to subject themselves to peer review processes. “These doctors allow their practice profile to be examined by the scheme as well as by their peers. Because they practice evidence based medicine, they are preferred by schemes in combating the ever escalating scourge of chronic diseases,” adds Dr Arens.
DPS specialists, whilst selected for their expertise are also very aware of the cost of healthcare technologies and often communicate the necessity and implications of such technologies with the patient before prescribing it. DSP pharmacies also offer a variety of services including, health education and couriering the medication to the address of the member’s choice at discounted prices. “This saves the patient unnecessary trips to the pharmacy or doctor to collect their medicines.”
Hospitals that serve as DSPs keep a watchful eye over wasteful practices. “These partnerships with service providers ultimately save the member from wasteful practice and uncontrollable escalations in contributions,” explains Dr Arens.
For their part, the schemes save in claims costs, while reserves are preserved. “I therefore encourage members to use the services of these DSPs for the abovementioned benefits associated with them,” says Dr Arens. “That said, members do of course have the right to voluntarily obtain services elsewhere, but need to remember that this may require co-payments from them.”
It is also in the members’ interest to negotiate discounts with service providers (including DSPs) in order to get even more out of their given benefits. “Where possible, paying the service provider in cash and then claiming from the scheme is another useful discount negotiating tool,” concludes Dr Arens.