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Doctors cautioned not to allow agreements with medical schemes to influence patient care decisions

03 April 2013 Anton van Loggerenberg, Bowman Gilfillan

Healthcare practitioners should be cautious when concluding designated service provider (DSP) agreements with medical aid schemes if the possibility exists that the quality of patient care is dictated by the agreement.

According to Anton van Loggerenberg, candidate attorney at Bowman Gilfillan, the pan-African legal services group, practitioners who conclude DSP agreements are at risk of breaching Regulation 7(3) of the Ethical Rules of Conduct for practitioners registered under the Health Professions Act of 1974.

This legislation stipulates 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”.

Mr van Loggerenberg commented: “In essence, the acceptance of any payment, benefit or material consideration by a practitioner from either a medical scheme or patient in circumstances where the practitioner’s treatment or management of the patient amounts to ‘under-servicing’ is prohibited.”

In a recent media release, the Health professions Council of South Africa (HPCSA) urged practitioners not to conclude agreements that may compromise the quality of patient care.

The HPCSA said that it was concerned that in certain circumstances medical aid schemes 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.

“While medical schemes have in the past been able to control patient care, the HPCSA’s recently stated position will no doubt be welcomed by the medical profession,” said Mr van Loggerenberg.

For example, conduct may be found to be unprofessional should a practitioner in compliance with a DSP agreement, recommend a laparoscopy to a patient diagnosed with colon cancer, without recommending or discussion the option of a laparotomy when this is a treatment option.

Mr van Loggerenberg said: “It is advisable for all practitioners, despite the existence of a DSP agreement, to safeguard themselves from acting unprofessionally by always discussing all available treatment options with their patients, and similarly, not to allow an agreement to influence their professional opinion in the treatment and management of a patient.”

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