16 August 2012

South Africa: BHF Backs Medical Tariff Guidelines

The Board of Healthcare Funders (BHF) has welcomed the introduction of the HPCSA Ethical Tariffs and believes that these tariffs will begin to provide certainty to medical schemes and their members on charges related to healthcare and will begin to address the ongoing cost escalation in the private healthcare sector.

Since the Competition Commissioner ruling of 2005, which prohibited medical schemes from discussing tariffs with healthcare service providers collectively, private healthcare costs have spiralled, resulting in membership to medical schemes becoming more and more unaffordable to the average working person.

Since the scrapping of the Reference Price List by the High Court in 2010, there has been no tariff or pricing guideline on healthcare provider charges, therefore allowing for opportunistic charging by some healthcare providers and putting severe strain on the pockets of patients.

"We feel that this is a much needed first step in bringing about certainty to medical schemes and their members. Nowhere else in the world is there a situation where healthcare providers do not have a pricing guideline to work off. Certainty in what a patient will pay for a procedure or a consultation is critical, especially in healthcare where the patient is sick and vulnerable at the point of service", says MD of BHF, Dr Humphrey Zokufa.

The BHF is also supportive of the fact that patients will have to be consulted if the healthcare provider wishes to charge over and above the HPCSA tariffs.

Dr Zokufa believes that this will ensure that patients are informed of the costs before the procedure is undertaken and will put the patient in a stronger position.

The HPCSA guideline tariffs also provide certainty on the procedure codes used by healthcare providers. Since 2006, the list of tariff codes have been manipulated and changed by some healthcare provider groupings, resulting in uncertainty in the medical scheme environment around the accuracy and the appropriateness of these codes.

The BHF believes, however, that the 2006 NHRPL upon which the new tariff guide is based, may not in all cases, reflect the real costs of providing healthcare. The organisation believes that it is imperative now for the industry to come together to arrive at a list of tariffs which accurately reflect the cost of providing healthcare and which are fair and reasonable to consumers, funders and healthcare providers.

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