‘The healthcare sector is in a state of flux. One of the latest casualties is the unity of different professional medical bodies and lobby groups.
‘New divisions are becoming evident in the apparent failure of representative bodies to promote the views and interests of frustrated members in the face of sweeping changes proposed by the Department of Health and its agencies,’ says Profmed’s Graham Anderson (pictured).
Anderson, principal officer of Profmed Medical Scheme was commenting on the resignation of Discovery Medical Scheme from the Board of Healthcare Funders (BHF) and the formation of the Specialist Private Practice Forum (SPPF), a group that was recently formed in response to the South African Medical Association’s seeming inability to act in the best interests of specialists in private practice.
Profmed is a restricted medical scheme which was initially launched as a scheme for members of the medical profession, but which subsequently widened its eligibility to include any person with a four-year degree, or two or more degrees that together constitute four or more years of study, which qualifies that person to provide a professional service.
However, a high proportion of Profmed members are general practitioners or medical specialists. The medical scheme therefore has a ‘foot in both camps’ and is sympathetic to member-medical practitioners who have dual needs; they wish to be members of a cost effective medical scheme, and as service providers they wish to be paid at rates that reflect the value of their professional services.
Profmed believes service providers should be able to charge appropriately for their professional services, even though schemes may not be able to reimburse at those rates.
Last year Profmed took an opposing stance to the Board of Healthcare Funders, when the medical scheme came out in favour of market forces being allowed to regulate fees charged by medical practitioners. The BHF supported Department of Health-initiated proposals that required that there should be a cap on fees payable to practitioners for certain mandated conditions.
At the time the health department's deputy director-general, Dr Kamy Chetty, acknowledged that the cap could slash doctors' income by more than 50%, but stood by the proposed legislation on the grounds that it would give more people access to private health services.
The legislation has subsequently been put on hold, pending the election of a new government in 2009 and the possible introduction of National Health Insurance.
More recently, Profmed again appealed for a fair deal for doctors after the announcement that the HPCSA, (the Health Professions Council of South Africa), a statutory body to which all medical practitioners have to belong, unexpectedly announced compulsory fee regulations for members.
In November 2008, the HPCSA announced that it had done away with the maximum ethical tariff charged by doctors and replaced it with a tariff code whereby doctors are obliged to get the permission of patients if they wish to charge more than the fee claimable by the member of a medical scheme. In the case of uninsured patients, doctors require permission to charge more than the National Health Price List, a medical price list designed by the Department of Health.
‘While the HPCSA decision may be good for medical schemes in the short term, we feel it will be disastrous for the health sector, both public and private, in the longer term. As a medical scheme we have to play our part to protect the long term needs of our members, we feel the long term supply of medical personnel is threatened by the new tariff code,’ said Anderson.
‘The Board of Healthcare Funders is mandated to represent the causes and interests of administrators and medical schemes. Unfortunately, medical schemes and administrators have differing priorities, which we believe has obscured the BHF focus,’ he said.
‘At Profmed we are alert to these issues. We, like other medical schemes, have had to evaluate what we are getting in return for our membership fees. Central concerns revolve around whether our interests are being addressed and taken forward to the Department of Health and the healthcare sector in general.
‘We are sympathetic to both Discovery and the break-away specialists, as we have experienced similar frustrations.
‘Just as specialists have different concerns to general practitioners, and public healthcare doctors have different concerns to the those who work in the private sector, the ‘funders’ represented by the BHF comprise of administrators who are allowed to make a profit and medical schemes, which are not.
‘It would not surprise me at all if some of these groups formed informal groupings to discuss areas of common interest,’ he said. ‘However, this may result in fractions instead of consensus in resolving the issues that face the healthcare sector,’ said Anderson.