Category Healthcare
SUB CATEGORIES General  |  HIV |  Medical Schemes | 

Who’s fooling whom?

19 February 2004 Staff reporter

The South African Medical Association (SAMA) has accepted the Competition Commission's ruling that the association was contravening the Competition Act of 1998, and will not publish a tariff as has been done in previous years.

According to SAMA chairperson Dr Kgosi Letlape, “SAMA has never been involved in price-rigging or price-fixing and has no intention of doing it in the future. However we will cooperate fully with the commissioner and abide by their decision.”

SAMA is concerned about how this decision will affect health care, though. The association is investigating other alternatives to assist doctors and patients when prices for services rendered are decided upon.

SAMA is also concerned about the inadequate benefits offered by medical schemes. The association will be taking this matter further with funders. Patients are thus urged to scrutinise schemes' benefits as compared to patients' contributions.

The Council for Medical Schemes (CMS) has recommended a 4,9% increase in medical benefits for 2004. “This is in sharp contrast with the significantly higher increases in patient premiums to many medical schemes for medical services.”

"It boils down to what patients are prepared to pay for quality services,” Letlape said.

SAMA has implored its members when determining professional fees to consider the financial position of the patient and discuss the financial implications of treatment options with them.

It is acceptable for a patient to negotiate fees for services or procedures with a doctor. Most practitioners are willing to give a discount on fees, but they are not obliged to do so.

Letlape adds that patients must prepare themselves for paying in the difference between the medical scheme benefit payout and the professional fee that doctors will charge for their services.

“More practitioners will also require patients to settle their accounts directly with the doctor before submitting their claims to their medical schemes for a refund of the benefit portion.”

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