Concern over comments on service providers

THE Board of Healthcare Funders (BHF) has reacted with concern to recent comments made by the Health Professions Council of SA relating to designated service provider (DSP) agreements.

According to the BHF, the council said in effect that healthcare practitioners should be cautious when concluding DSP agreements with medical aid schemes. It said schemes tried to reduce costs by applying pressure on practitioners within DSP networks to prescribe medication or to recommend treatment options, when other more appropriate, albeit sometimes more expensive, options were medically indicated and readily available.

BHF CEO Dr Humphrey Zokufa says the board’s view is that this undermines the legislation which allows for DSP contracting.

“In the current environment where there are no regulated tariffs for healthcare procedures and runaway increases in healthcare costs, the ability for medical schemes to contract with DSPs is one of the only ‘tools’ they have to bring about some kind of certainty in the charges by healthcare providers. Without this, medical schemes would lose one of the most important mechanisms for containing costs for their members,” he argues.

“It is the BHF’s view that over-servicing, rather than underservicing is far more prevalent in the private healthcare industry. Thus, the cautionary offered by Regulation 7(3) of the ethical rules of conduct for practitioners registered under the Health Professions Act of 1974 is extremely pertinent.”

This legislation states that practitioners “shall not offer or accept any payment, benefit or material consideration which is calculated to induce him or her to act or not to act in a particular way not scientifically, professionally or medically indicated or to under-service, overservice or over-charge patients”, Zokufa says.