Tamar Kahn: Business Day,
THE government has signalled its determination to regulate private healthcare prices, publishing a revised version of the controversial National Health Amendment Bill that makes little concession to industry criticism of the version first flighted two months ago. A potentially far-reaching exemption for doctors and specialists, which seemed to acknowledge fear that the original bill might prompt a massive flight of skills, was apparently removed at the eleventh hour. According to the May 26 version of the bill, healthcare providers were to be allowed to charge rates above the industry tariff guide, known as the National Health Reference Price List (NHRPL). The exemption was scrapped by the Health Department before the bill was submitted to the cabinet two days later. A study by the South African Medical Association found two-thirds of its members said they would consider emigrating if their fees were regulated by the government. Private hospitals reacted with dismay to the revised bill published in the Government Gazette and submitted to Parliament. Netcare's head of funder relations, Mark Bishop, said that the changes appeared to be cosmetic and that it was still very much price regulation. He said that of concern was that the proposed facilitator was not independent, and neither the facilitator nor the Health Department accepted any liability should the results of the regulations cause damages to any organisation or individual. He added that this left one with the impression that the department itself had a lack of faith in the proposed legislation. The first version of the bill envisaged annual price negotiations between medical schemes and healthcare providers - healthcare professionals and private hospitals - taking place under supervision of a facilitator appointed by the Minister. They could appeal to a powerful tribunal if they failed to agree on rates. The private healthcare industry criticised the bill for being in conflict with the Competition Act as it allowed collective bargaining. Medi-Clinic CEO Koert Pretorius described the powers it gave Health Minister Manto Tshabalala-Msimang as "Draconian". The bill was said to be vague, impractical and at odds with existing law. The revised bill sets the NHRPL as a price ceiling for the basic basket of care all medical schemes must provide to their members, known as prescribed minimum benefits, but allows parties to negotiate lower rates either as collectives or bilaterally. The NHRPL is already used as a tariff guide when medical schemes and service providers set fees, but it is not legally binding. The bill says the agreed tariffs will apply not just to medical scheme members, but also to people who are uninsured, and foreigners. The new bill says the Minister must call for public nominations for the facilitator who will oversee tariff negotiations, to be aided two to five assistant facilitators. It scraps the tribunal and its inspectors in favour of an arbitration process that will allow aggrieved parties to choose their mediators. Only if the parties cannot agree on a mediator will the Minister step in and appoint one in consultation with the Justice Minister. Kurt Worrall-Clare, CEO of the Hospital Association of SA, said that Hasa had fundamental concerns around the competition consequences of this bill. He asked how it could be reconciled with the Competition Act's prohibition of price collusion. The government also submitted the revised Medicines and Related Substances Control Amendment Bill to Parliament. This provides for the creation of a regulatory body to replace the Medicines Control Council. The bill has not been changed significantly, and retains controversial provisions to allow the Health Minister to turn down a medicine or device on the grounds that it is not in the public interest for the product to be made available in SA.