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8 th August 2009
SURGICOM NEWSLETTER AUGUST 2009
ANNUAL GENERAL MEETING HELD IN CAPE TOWN : 8 TH AUGUST 2009
FOR THOSE OF YOU WHO ATTENDED, A SUMMARY, AND FOR THOSE WHO DID NOT,
A REPORT ….
First of all at the ASSA Exco meeting the new SAPPF was addressed. The
feeling was cautious, the reason is the cost involved.
SAPPF has taken the DoH to court. The reason in short is that DoH did not
respond to either the Commission Board's decision to formalise a proper coding
system, or the fact that besides asking all specialties to do cost studies, they
not responding, nor are they verifying and /or acting on the outcome.
It is the feeling amongst many of us that the cost studies have totally taken
the DoH by surprise, in that they thought we were overpaid instead of being
seriously underpaid by a factor of three.
The legal costs, to get where we are today, have cost SAPPF R3.4 million. And
more costs are envisaged. How can this cost be accrued, and what is expected
from us. Before responding to that, let us first look at SAPPF again, and list
the Pro's and Con's for Surgicom and ASSA.
- Surgicom is the Private Practice Management group and company which was
formed to look after the well being of everybody doing private practice –
fulltime or part time, even if only a few cases per month. Despite regular
Newsletters, sent by e-mail, and posted, with a SMS reminder, our membership
is not what it must be and at the moment 50 % of Surgeons are carrying the
costs of what we are doing. This is our first and foremost NEGATIVE. Our
Board and especially those of us dealing with SAPPF matters are using up a
lot of time in the effort to really actively support and improve our case.
- We need the drive to get everybody involved, please talk to your
neighbour, your friend, your associate, your colleague in your hospital,
make sure to include the younger guys who are just starting practice, they
are the ones that will benefit most, because I believe that our efforts will
not be in vain. If we can do that and have a response that will be a huge
POSITIVE.
- SAPPF is really necessary. The treatment we received at SPPC, as part of
SAMA, has been seriously neglected, and we have to support an organisation
that will be listened to and will act on behalf of all Specialists in the
country. By doing this in a pure business manner with fulltime CEO and
office is a very strong POSITIVE.
- The legal process is necessary, and the outcome will be a strong POSITIVE,
the reason is we go to court on settlement unopposed, and we can therefore
only win. Attached the press release from SAPPF that speaks for itself.
- The cost of legal action is huge, and those of us involved in SAPPF
matters will surely contest this and will ask for a full cost taxation. We
are assured that a SAPPF task team is looking into this as well as trying to
keep the costs as low as possible. The cost so far is a NEGATIVE, as we are
respondents in the case and therefore liable to pay our share. Again with
dwindling membership numbers this is of great concern, and again we urge you
to participate and partake.
- SAPPF as a body and the influence through that body must be used in the
NHI saga that will be the next challenge. Already Funders and Hospital
groups are relating with us, and our input once the green paper is published
may just be of great importance to secure our positions in practice. This
again a large POSITIVE.
To come back to our first question as to how we should then further proceed:
- We should work as a group and not as individuals
- We should be able to increase our membership
- Unity is of great importance and individual standpoints must be heard and
accommodated, don't just disagree, speak out so that we can all benefit from
your opinion.
- We are respondents to the court case and liable - let us carry the burden
together.
- We should as a company, and as a group, join in the activities of the
SAPPF.
At the AGM the financial report was presented by Hans Verhave. Our base is
solid but expenses soar, mainly because of our involvement in :
- Spesnet
- SAPPF (if we were to keep both we must increase our membership fee).
- The Psychiatrists pay R 1000.00 per month to their management group as
well as to their Association. We will have to do the same if we are to keep
up with our commitments.
- I calculated R250.00 for SAPPF, R300.00 to Spesnet if we include that and
R200.00 for Surgicom = R750.00 per month.
I will propose this at our next Board Meeting.
To quote our ex Chairman (Mike Wellsted) “It is inappropriate that ASSA and
Surgicom members should shoulder all the costs and we need to plan how to
approach non member surgeons and collect funds from them for the legal costs and
for that matter, the coding development.”
This Newsletter will be send by post, E mail be posted on our Website and a
reminder sent by SMS. PLEASE READ!
Dr Jan Mook
Chairman
SURGICOM LIMITED Telephone : (011) 706 4815 Telefax : 086 556 2232
Email :
surgicom@worldonline.co.za
Website : www.surgicom.co.za
Press Release – SAPPF 6 th th August 2009
DOCTORS GO TO COURT TO ENSURE REALISTIC TARIFFS
In April, a number of associations (representing thousands of specialists,
general practitioners and allied health professionals) launched a judicial
review of the Director-General of Health's determination of the 2009 Reference
Price List in the North Gauteng High Court. The Director-General did not file a
notice of opposition to the application and the parties have been in settlement
discussions since the launch of the application. These settlement discussions
have recently failed and the applicants have decided to proceed with the
application. The matter has been set down to be heard on Tuesday 22nd September
2009.
The issues at stake in the application are complex and have far reaching
implications for the provision of health services to the people of South Africa
. The applicants believe that the Director-General has failed to determine an
accurate Reference Price List (the RPL) which reflects the real cost of
providing health care. Further, in determining the 2009 RPL, he has failed to
comply with the law in a number of respects. For example, he did not give many
of the applicants proper reasons for his determination of the RPL, rejected some
of the applicants' submissions without good reason and he failed to properly
verify the applicants' submissions on the RPL.
The need to ensure that South Africa has a properly determined and
reality-based RPL is about ensuring that South African doctors are able to
provide the best quality health care and that patients are able to access this
health care. Independent observers rate the South African private health sector
highly, with the Monitor Group rating it 4th on quality and only the 22nd most
expensive, out of 41 countries in a recent survey. It is the very survival of
this excellent service which is at stake in this case.
The RPL was introduced in 2003 after the Competition Commission put a stop to
tariff negotiations between doctors and medical schemes, and the RPL was
conceived as a guideline to enable medical schemes to determine their benefits.
The RPL is meant to be based on the cost of providing health services. Making
cost explicit in the price was intended to enable the DOH to put a brake on what
was perceived to be rampant inflation in the medical schemes industry - a
process driven by the presumed high prices being charged for professional
services.
Following some initial reservations about the model, and a warning that the
process was likely to reveal the opposite of what was apparently expected by the
DOH, i.e. that the tariffs for medical fees were in fact unrealistically low,
the medical profession agreed to participate in the process and then proceeded
to spend many hundreds of hours, and great sums of money producing cost studies
in compliance with the regulations. These studies were duly completed and the
applicants made submissions to the DOH in May 2008.
However, when the draft 2009 RPL was published by the DOH it was announced
that only 11 of the 48 disciplines submissions had been accepted for
verification, rejecting the remaining 37 submissions. In addition, when the
final 2009 RPL was published in December 2008, all of the disciplines were given
an across the board inflation indexed increase of 10.7%, instead of the
anticipated cost based increase as required by the regulations. The applicants
were exceptionally disappointed that, despite the hours of work and the sums of
money spent in order to compile their submissions on cost of services, the DOH
simply ignored the studies and applied an across the board inflationary
increase.
The cost studies indicate, just as the profession had said they would, that
professional fees are far too low, and that the required increases would exceed
by far the 10.7% adjustment for inflation. There was also in most instances no
good reason for the DOH rejecting the costing submissions. Although verification
of the submissions should have preceded publication of the draft 2009 RPL in
2008 the process is still, in July 2009, not complete (i.e. more than a year
after the costing studies were submitted to the DOH).
The cost studies mandated by the RPL regulations have shown something that
doctors for many years have understood - that the benefits allowed by most
medical schemes, which rely on the RPL as a guide, were priced far below what
the services cost to provide, and that doctors, far from being greedy
capitalists (that some politicians have chosen to portray them as) , are in fact
simply trying to do their jobs and make a decent living.
Despite working with a price list that, it is now clear, is significantly
below cost, doctors have continued to provide a world class service, the envy of
many competitors in other parts of Africa and the world. How has this been
possible, if the profession is indeed so poorly remunerated? How is it that
doctors are still in business and have not all filed for bankruptcy? The answer
lies in the long hours that they are forced to work, and by virtue of the
ability to charge a co-payment. Co-payments are out of pocket expenses met
directly by the patient without recourse to their medical scheme.. The
difficulty with this is that working long hours and charging co-payments are not
good for the doctors or patients and are definitely not a long term solution.
The court application is a last resort attempt to try to ensure that the
Director-General considers the long term interests of both patients and doctors
when determining the RPL.
The implications for the patients who use private services, and for the South
African economy, if the RPL is not calculated so that it accurately reflects the
cost of private health services, are dire. For robbed of their ability to earn
even a reasonable living, many doctors are likely to take their earnings and
their taxpaying capabilities elsewhere. And with them, many other skilled
professionals are likely to follow. When one considers that medical scheme
members also contribute about 80% of the taxes that fund the state health
services, the loss of potentially thousands of tax payers to the South African
economy would be dire indeed. For these reasons the applicants in this case
believe it is vital that the DOH be compelled to produce a RPL that is a true
reflection of the costs involved in providing a private health service. The
applicants would prefer not to have to go to court, but because of the current
stance of the DOH, have been forced to do so.
The applicants are determined to fight for a defendable and realistically
priced RPL; for the sake of all patients who already benefit from the high
quality health service currently available in the private sector, and for the
many thousands of South Africans, who hopefully in the near future, will also
benefit from the care of these self-same dedicated professionals, working in an
expanded national health insurance health service, that pragmatically has found
a way to accommodate the private sector.
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