Discovery Health welcomes SAMA statement

Discovery Health today welcomed the earlier statement released by the South African Medical Association (SAMA) Specialist Private Practice Committee (S-PPC) , the official representative body for specialists in private practice in South Africa, that engagement with the private healthcare funding industry is the preferable strategy to achieve increased remuneration for specialists, and that SAMA is working with Discovery Health to arrive at suitable solutions.

Neville Koopowitz, CEO of Discovery Health Ltd, welcomed the statement, and a statement from the Physicians Association of South Africa released on Tuesday 21 August, reaffirming Discovery Health's commitment to building the private healthcare system for all stakeholders: "We have introduced initiatives to pay specialists more, reduce gaps in members cover and ensure a spirit of cooperation and transparency between healthcare funder and healthcare professional. The statement from SAMA reflects the progress we are making."   

Koopowitz stated: "To date over 3 300, (nearly 70%) of all specialists in South Africa, benefit from our direct payment arrangements. The Discovery Health Medical Scheme has increased remuneration by up to 50% for participating specialists during this year. And we continue to work with all stakeholder groups to find solutions to accommodate even more healthcare professionals on these and similar structures."

"At the core of our approach," said Koopowitz, "is our belief that health professional remuneration levels, as represented by the tariffs covered by medical schemes, have lagged behind expectations in recent years, and also do not take adequate account of the changing nature of specialist practice and the growing shortages of specialists in many disciplines. At Discovery Health we firmly believe in the cornerstone role healthcare professionals play in the delivery of the high quality private healthcare available in South Africa today. We have consciously set out to take positive steps towards paying doctors more. In that process, we must also ensure that our medical scheme members are not exposed to co-payments and gaps in their cover. We must also ensure that increased remuneration remains affordable for the medical scheme, and does not lead to unaffordable increases in premiums. It is finding this balance that is our critical challenge, one we believe we are achieving with the introduction of our new reimbursement structures, such as the Premier Rate."

Jacky Mathekga, Principal Officer of the Discovery Health Medical Scheme, emphasizes the importance of finding solutions that protect members of the medical scheme: "At the Discovery Health Medical Scheme we need to ensure our members are not exposed to unquantifiable, and increasing gaps in cover when consulting their doctors. It is for this reason that we have invested significantly more of the medical scheme funds to healthcare provider remuneration. In return, our members have access to a significant and growing number of specialists who have chosen to participate in these remuneration structures, such the Premier Rate, and know that they will have no co-payments and their doctor will be paid directly by the medical scheme.

Koopowitz acknowledges that criticism leveled against Discovery Health concerning the manner in which they introduced the Premier Rate is valid. He emphasizes that Discovery Health has addressed these concerns actively, and has been interacting with the leadership of numerous industry bodies, and specialist associations over the past year to find solutions that meet the needs of the doctors in a sustainable manner. "We have had numerous open and vigorous debates with various doctor groups, and it has been this willingness to engage by all parties, that has lead to what has been achieved to date. I believe we can, and will, do much more, working together."

Commenting on the "Specialist Advocacy Group" that has been quoted in the media as opposing Discovery Health's approach, Koopowitz stated, "We are most concerned that on the fringes there seem to be a small group of detractors who seem skeptical about Discovery Health's intention around these direct reimbursement options. Hopefully over time it will become clear that our intentions are for the betterment of the healthcare system and to the benefit of members and doctors. That said, we are aware that these reimbursement arrangements will not meet the needs of all the specialists. Discovery Health respects the individual specialist choices as to their preferred method of charging and payment We believe strongly in the role of private healthcare in South Africa - at the end of the day the benefit to the vast majority of doctors must out weigh the remuneration aspirations of those on the fringe; in this way members will win as will the healthcare system as a whole."