The Board of Healthcare Funders has requested the Competition Commissioner to investigate anti-competitive practices by the South African Medical Association (SAMA) relating to fees charged by medical practitioners.
In the media recently and in a letter to BHF, SAMA has indicated that it will be advising doctors to charge fees more than 300% of the medical aid rate.
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BHF is very concerned that this will jeopardise consumers in the following ways:
- Medical scheme members may be forced to pay the cost of the full consultation upfront and then claim from the medical scheme.
- The cost of the consultation may be more than triple what medical schemes are permitted to pay in terms of their rules.
- Medical scheme members may have to pay an out-of-pocket portion of the bill of approximately double the amount of what the medical scheme is permitted to pay.
Despite the best efforts of the medical schemes industry and government to increase access to private healthcare funding to more South Africans, these actions on the part of healthcare practitioners nullify the advances made by government on the reduction in prices of medicines, making it difficult to pass on these savings to consumers.
Medical schemes have been under pressure to keep contributions down but are unable to do so in the face of continuously increasing healthcare costs. This is compounded by the fact that medical schemes are obliged to pay the full cost of the nearly 300 Prescribed Minimum Benefits which include many conditions which are mostly treated in hospital by specialists, and therefore costly.
The Registrar of the HPCSA has advised consumers in his press release of the 13th October 2006 that they should guard against being over-charged by their healthcare practitioner and that doctors who charged at a rate higher than the medical aid rate will be viewed as overcharging the patient unless consent is obtained from the patient beforehand.
BHF therefore advises all members of medical schemes to ascertain what they will be charged before a consultation.
For further information, please contact Heidi Kruger, Head of Corporate Communications at BHF
Please click here to view the HPCSA press release