THE Board of Healthcare Funders (BHF) wants regulation 8 of the Medical Schemes Act to be rewritten. The organisation, which met with the Minister of Health three months ago, said the regulation, which governs the payment of prescribed minimum benefits (PMBs), negatively affected medical scheme contributions. BHF spokeswoman Heidi Kruger said Regulation 8 had had unintended consequences in that it had allowed an open-ended liability for schemes, adding that the Council for Medical Schemes' (CMS's) interpretation of this regulation was that schemes must pay for PMBs in full irrespective of the amount charged. Kruger said that as the regulation was written and interpreted by the CMS at the moment, the balance of power rested entirely with the provider of service as he or she not only decided on the diagnosis and how to treat the condition, but also was able to decide on the quantum. The CMS said it had, together with the Health Department, made proposals to the Minister to revise PMB regulations in a way that dealt with the concerns raised by the BHF. According to the CMS the process had been inclusive and included the full range of affected parties. The PMB basket includes any emergency medical condition, 270 diseases and 25 chronic conditions. A workshop will be held next week to discuss the issue of non-compliance with PMB cover and to set up a task team to ensure compliance. While doctors say they also have some concerns with the PMBs, they are unimpressed with the BHF's move and have accused the organisation of not consulting with practitioners. The SA Medical Association (Sama) said any manipulation of tariffs should be a joint engagement among stakeholders. The association said it would always cause anxiety if the BHF wanted to make changes itself and added that it was also unhappy about certain aspects of PMBs because there were essential conditions not covered. Sama chairman Norman Mabasa said that primary healthcare conditions were not particularly well covered and that was why benefits got exhausted so quickly. Lex Visser, the chief executive of the Alliance of SA Independent Practitioners' Associations said that if there should be changes, all parties should sit down and come up with a solution that protected everyone. He added that no-one had ever done research on what doctors charged for PMBs. The Hospital Association of SA declined to comment as it had not seen the proposal. Kruger said everyone would be able to comment on the amendment once the regulation had been rewritten. A report in the MEDICAL CHRONICLE said the Department of Health was looking at setting up an independent commission that would be responsible for setting tariffs in the industry. The Health Department did not respond to request for comment, but the BHF and Sama welcomed the idea.

Slindile Khanyile: Business Report, 6 May 2010