What you should pay your GP
2012-08-12 10:00

Zinhle Mapumulo

Pricing of services in the private sector is abnormal and unacceptable, says Health Minister Aaron Motsoaledi.

The Health Professions Council of South Africa (HPCSA) has once again tried to set guidelines for what doctors in the private sector should charge – but its proposed fees may land it in hot water with the sector.

The guidelines outline what the council believes healthcare practitioners should charge patients for consultation, treatment and care.

Previous fee guidelines for the private sector have been booted aside in court or set aside in favour of newer documents.

The council says the new tariff guidelines are a fair interim measure that could end the current billing confusion in the private healthcare sector and protect patients from being overcharged.

But the South African Medical Association (SAMA) disagrees.

The association’s acting chairperson, Dr Mark Sonderup, said: “The new guidelines will create more problems than a solution because they are not realistic.

“The HPCSA met with us and other stakeholders last year to discuss the guidelines but it appears nothing we said was incorporated in the new guidelines.

“They failed to consider various factors that practitioners use when determining the tariffs, including the area they practise in.”

The HPCSA’s registrar, Dr Buyiswa Mjamba-Matshoba, explained: “The new tariff guidelines are not what doctors should charge but what they are expected to charge.

“The council is cognisant of the fact that practitioners have a right to charge fees commensurate with a number of factors such as their area of expertise, market segmentation of their client base and area in which they practise.

“However, the practitioner has a responsibility to inform the patient what he or she is charging, so that they can make an informed decision,” Mjamba-Matshoba said.

However, the council is planning to use the guidelines when adjudicating complaints of overcharging – so doctors will ultimately be held to them.
Most of the complaints the HPCSA receives each year from patients relate to overcharging.

The absence of tariff guidelines in South Africa’s private healthcare sector for the past two years has made it tough for the council to finalise these complaints.

The last private healthcare tariffs guideline was the National Health Reference Price List (NHRPL), which was declared invalid and set aside by the North Gauteng High Court in July 2010.

The court found that the processes relating to obtaining information, determining prices and publishing it were flawed, as not all stakeholders were
consulted.

Before that, there was the council’s ethical tariff guidelines, which were scrapped in 2008 when the NHRPL was published.

Sonderup said: “The new guidelines are taking the industry back to 2010. The R255 that the HPCSA expects GPs to charge is 10% below what they should be charging.

“We are disappointed by this whole exercise because it will take (us) back to (an) altercation that could have been prevented,” Sonderup said.

Meanwhile, Health Minister Aaron Motsoaledi has announced that the long-awaited pricing ­commission, which will regulate the private health sector, will be established next year.

Motsoaledi revealed this when he addressed delegates at a Board of Healthcare Funders meeting in KwaZulu-Natal last week.

He said: “The pricing of services in the private sector is abnormal and unacceptable – it must change.”

The Board of Healthcare Funders, which represents more than 80% of South Africa’s medical schemes, welcomed the minister’s announcement.

Fact box

The HPCSA has proposed a number of new tariffs for doctors and other health professionals working in the private sector. These are the prices you, as a patient, can expect to pay if the tariffs are adopted:

» GP consultation: R255

» Completion of chronic med form: R322

» Pregnancy ultrasound: R444

» Normal delivery and obstetric care from beginning of labour until post-partum: R2629 plus R351

» Exclusive attendance to a baby after C-section or normal delivery: R496

» Pre-anaesthetic assessment: R240

» C-section and obstetric care from beginning of labour until post-partum: R2489 plus R351

– City Press