Doctors urged to shun medical scheme fee bundles
The Health Professions Council of SA has urged healthcare professionals not to sign agreements with medical schemes that bundle the money available for procedures such as hip replacements into a global fee, citing concerns over patient safety and doctors’ autonomy.
If the council’s call is heeded, it would throw another spanner in the works for medical schemes that want to introduce global-fee arrangements to try to contain costs.
Discovery Health Medical Scheme, SA’s biggest open medical scheme, has already had to delay plans to introduce global fees for hip and knee replacements in a network of arthroplasty centres on April 1 because of the concerns of the South African Society of Anaesthesiologists and other specialists.
Global-fee reimbursement models provide a single payment to a healthcare team to cover all the tests, procedures, drugs, devices and rehabilitation needed for a patient’s condition, a vastly different approach to the current fee-for-service model whereby medical schemes reimburse each healthcare provider individually.
“We are not trying to obstruct them [Discovery], but we want them to get the mechanism right,” said the society’s CEO, Natalie Zimmelman. “Discovery is working with us to try and find a way forward — some other schemes are less amenable.”
Discovery principal officer Nozipho Sangweni said the scheme was engaging with professional associations and hoped to achieve global fees that were acceptable to the council.
“We believe firmly that global fees pose no substantive ethical concerns and can be structured to ensure ethical practice. This approach is consistent with global best practice and is certainly the most effective way to ensure optimal health outcomes and efficiency,” she said.
The council issued its warning after the society of anaesthesiologists and the South African Arthroplasty Society highlighted potential risks they believed global fees posed for patients as they created incentives for underservicing, said HPCSA chairman Kgosi Letlape.