New price list for doctors soon

Jul 04 2013 09:24
Nellie Brand-Jonker, Sake24
Cape Town. - Consumers could possibly have a price list January 2014 that will help them determine whether a doctor or dentist charges exorbitant prices.

Shivani Ramjee, a health actuary and head of actuarial science from the University of Cape Town, has been appointed by the Health Professions Council to help guide it to compile guidelines "scientifically".

The council hopes to have the guidelines ready by January.

The question of excessive or unethical prices has been a major headache for most consumers, medical practitioners and medical aids and the council has been unable to fulfill its statutory mandate for years to assist consumers with their complaints about prices.

The Health Professions Act makes provision for the council to set up price guidelines and deal with complaints of excessive pricing.

The council’s effort to establish such guidelines in 2012 was criticised to such an extent that the guidelines were withdrawn.

A decision was subsequently taken to start the whole process from scratch.


The closing date for comments was earlier this year and Ramjee said more than 80 submissions had been received.

A successful meeting with stakeholders took place in April.

She describes the determination of price guidelines in South Africa as "complex and messy."

The High Court in 2010 set aside a referrence price list compiled by the department of health.

The council had once published a guideline that recommended prices three times (300%) more than the reference price list, which was unethical.

In 2008 the council approved guidelines that patients had to give written consent if prices were more than those on the price list, otherwise it could have been regarded as excessive.

Ramjee said because there wasn’t a reference list, the council didn't have anything to compare prices to see if they were excessive.

"This has resulted in patients being charged exorbitant prices without proper protection," the Consumer Commission said in its submission.

Medical funds are mostly using the 2006 price list (which has not been waived) and adjust it for inflation to determine what percentage of the price they will pay or they negotiate individually with doctors.

In 2012 the council drew up concept guideline tariffs with reference to the 2006 reference list by adjusting prices for inflation.

Collective bargaining

Ramjee said the ultimate format of the guidelines would be something like the reference price list, which provided medical procedures codes to which a price had been attached.

Currently the process was determined by the value of each code.

 The Competition Commission will ultimately  have to rule.

"This will give patients an objective reference point to determine how reasonable the price is.

“ There is no such thing at present and patients have no idea whether the price is normal or not. "

Price guidelines:

* The Board of Health had a list of recommended prices for medical funds until 2004, which had been negotiated with the South African Medical Association. However, the competition authorities prohibit collective bargaining;

* The Council for Medical Schemes then published the national reference price list on behalf of the department of health in 2006.

*The department started publishing the reference price list in 2007.

* The Health Professions Council abolished its ethical tariff determination in 2008. (According to this, prices more than three times the recommended price would be unethical) because it felt that the prices on the reference price list would be fair compensation for doctors.

* In 2010, the department's reference price lists for 2007, 2008 and 2009 were set aside by the High Court,  partly because the right procedure had not been followed.

* Some medical schemes have been using the price list since 2006 and adjust it for inflation.

* Since there is confusion about prices. This prompted the council in 2012 to draw up new guidelines on the basis of the 2006 reference price list, which has not been set aside by the court.

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