Doc­tors to fight tar­iff list in court

Weekend Argus (Saturday Edition) - - PERSONAL FINANCE - LAURA DU PREEZ

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.

PRICE LIST

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.

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