Chantelle Benjamin
8 August 2007
Johannesburg — THE trustees of Discovery Health Medical Scheme have agreed to meet with specialist doctors to resolve the growing public spat over a new payment plan that has seen payouts to medical practitioners decrease, although premiums for the scheme's members increased.
Chris Joseph, president of the South African Society of Otorhinolaryngology Head and Neck Surgery, said yesterday that the forum had requested a meeting with the trustees, rather than with the administrator."The trustees have agreed to meet us and we are finalising a date that suits everyone," said Joseph.
He is also the founder of the Specialist Advocacy Forum -- a lobby group which focuses on informing specialists and protecting their rights.
In a two-week media blitz, Discovery Health denied claims that it was charging members more for fewer benefits, saying that the payment plan, called the Premier Plan, was intended to provide better remuneration for specialists, direct payment to medical practitioners and no gaps in cover for members.
It also admitted that it was concerned that "unsubstantiated" claims by a small group of specialists would have a negative effect on its members.
About 200 specialists, largely in Johannesburg, Western and Eastern Province and KwaZulu-Natal put notices up in their offices last month saying that they would no longer deal with the country's largest medical scheme which they have accused of a lack of transparency and coercion.
Their main objection had to do with Discovery's Premier Plan, which introduced direct payments of 200% (of the National Health Reference Price List) from the end of last year to doctors and specialists who signed up to be placed on a preferred provider list.
Discovery's standard practice is to pay their members who then pay doctors or specialists. Joseph said the practice was coercive, especially since Discovery's top plan, Classic Comprehensive, last year offered 300% cover for private rates, but this year offered only 200%, despite an increase in premiums. Discovery Health said that 3100 specialists had signed up for the scheme.
Jonny Broomberg, head of strategy for Discovery Health, said the dispute with a group of specialists was cause for concern. "We have always had a close working relationship with health care professionals and we value specialists, who are in great demand in SA," he said.
"Our commitment to specialists is to pay them more, pay them directly and protect our members against co- payments in a way that is sustainable and responsible. Our direct reimbursement models don't require specialists to change the way they treat patients."
Broomberg said administration costs had reduced over the past five years to 10,7% of members' contributions, while specialist and hospital remuneration had increased to 15%. This was disputed by Joseph, who said administration costs are closer to 15% if managed care costs were included.
Discovery's argument that its average contribution increase was well below the industry average of 11%, at 7,9% and included benefits such as full cover for generic medicines, is also disputed by the forum which said it wanted to know if this only looked at principal members or included increases for dependants.
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