Doctors to fight tariff list in court
Private doctors are continuing with their High Court challenge of the Department of Health’s guideline tariffs for private medical services.
Associations representing thousands of specialists, general practitioners and other doctors say they plan to go ahead with their court application, which is due to be heard on September 22.
The application for a judicial review, which was launched in the North Gauteng High Court in April, asked the court to instruct the department to produce a revised 2009 Reference Price List (RPL).
Many medical schemes base their benefits on the RPL and many doctors base their fees on it.
According to a statement put out by the South African Private Practitioners’ Forum and 22 other professional associations that represent general practitioners and specialists, the director-general of the health department did not give notice that he planned to oppose the application, and the parties instead entered into settlement discussions.
The forum says these discussions have failed and it has therefore decided to proceed with its court action.
It claims in its application that the RPL is unlawful, procedurally unfair and/or unreasonable.
Anban Pillay, a spokesperson for the department, says its legal department and the director-general are still considering the application, but the department will release an updated 2009 RPL within a few weeks, following verification of information submitted by practitioners in 11 disciplines about their practice costs.
The RPL was instituted after the Competition Commission in 2003 put a stop to negotiations between healthcare providers and medical schemes over tariffs.
The publication of the RPL was taken over by the Department of Health in 2006, but a lack of regulations governing the process under the National Health Act delayed publication until the 2009 list was produced last year.
Before publishing the list, the health department called on private healthcare providers to submit information on the costs of running their practices, to assist it in determining appropriate guideline tariffs. However, the department then rejected many practitioners’ cost studies and the 2009 RPL largely reflected a 10.7-percent increase in the guideline tariffs used in 2008.
The department indicated that only 11 of the 48 medical disciplines had submitted suitable cost studies, and it would consider higher tariffs for these disciplines only. Pillay says these revised tariffs will be released within the next few weeks.
The Private Practitioners' Forum, however, is attacking the process that produced the RPL, saying Thami Mseleku, the DirectorGeneral of Health, failed to comply with the law by, among other things, not giving proper reasons for his determination of the RPL, rejecting some submissions without good reason and failing to properly verify submissions on the RPL.
Pillay says the department has to insist on a particular sample size for practice cost studies submitted to it as part of the RPL process, otherwise it would be sent only the studies indicating the highest costs.
The forum says a properly determined, accurate RPL is important to ensure that South African doctors are able to provide the best quality health care.