The Board of Healthcare Funders of Southern Africa is concerned that moves by SAMA to halt the publishing of the NHRPL for 2007 will thwart the medical schemes’ industry and government’s attempts to bring about greater affordability and access to private healthcare.

The National Health Reference Price List provides medical schemes with guidance in terms of reimbursements to healthcare providers and without this guide, fees charged by healthcare practitioners may spiral.
“Our concern is that more healthcare professionals would gravitate towards the Health Profession’s Council price list which is on average 300% higher than the NHRPL, with some doctors charging as much as 500% of the NHRPL”, said Dr Rajesh Patel, Head of Benefit and Risk at the Board of Healthcare Funders.

BHF’s preliminary analysis of claims data for the first half of 2006 indicates that specialist costs have risen by 20% in-hospital and 30% out of hospital, about 5 times higher than CPIX. This trend undermines attempts through the Health Charter and the Low Income Medical Schemes initiative to bring about affordable and accessible private health cover.

“The methodology used by the Health Professions Council of SA to arrive at their price list has also been brought into the spotlight by BHF as, in terms of legislation, these prices are meant to reflect the ‘norm’, said Dr Patel. “It is therefore difficult to understand how costs which are 300% higher than the NHRPL can be seen as a norm”, he said

BHF will be engaging with the Department of Health as well as the Council for Medical Schemes on the way forward and to ensure that stability is maintained in the medical schemes sector.