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29 September 2009

MEMBERSHIP AND FEES

Dear Doctor

In December 2007, the ANC announced the introduction of the National Health Insurance Plan (NHI) as part one of the top priorities for Government. Since then the environment for private practice has changed significantly.

The National Health Amendment Act was drafted in 2008, mandating the (National Health) Reference Price List (RPL) as the legal maximum tariff for medical services. Subsequently the Health Professions Council of South Africa (HPCSA) published regulations, announcing the RPL as the maximum ethical tariff for medical services, indicating that this was necessary for the introduction of the NHI.

The events indicated to us, that Government is serious about the introduction of the National Health Insurance and to regulate prices and fees for medical services. The legislation and ethical guide was challenged and withdrawn for now.

As we all know, SASOP and the PsychMG have for several years now submitted cost studies to the National Department of Health (DoH) to get to a cost based RPL. We have submitted separate cost studies and although this has benefitted us greatly, we are still not yet at a cost based structure. Most other disciplines did not present the DoH with cost studies and now need an adjustment of as much as 229%, whilst we need an adjustment of 56%.

If, as Government and the HPCSA have indicated, the RPL would become the maximum fee for medical services in the public and private sector, and we are not at a cost based structure, few medical practices would survive economically. We thus had no other option but to take the Department of Health to court to force them to complete their review of the submissions, follow the law that regulates the RPL process and publish a cost based RPL. The total fee for the court case is estimated at R6,000,000-00. The legal fees are already more than R3,000,000-00 and we have not yet gone to court. We had a date set for the 22 September 2009, on the unopposed role, but was firstly been moved to November 2009 on the opposed role and now to February 2010. The reasons for the changes in dates have been due to our application to the Judge President of Northern Gauteng to have our case heard with The Hospital Association of South Africa (HASA), ER24 and Netcare911. This was granted and the hearing is now set for the 22 nd -24 th February 2010. This is a battle we have to pursue and win as we move into a National Health Insurance environment.

The ANC also announced the introduction of a National Health Insurance in the next 5 years in December 2007. We are already 1 year and 10 months from there and we still do not have an official Government document to guide us and relieve the uncertainty of the plans and the subsequent place of the private sector in this scheme. A resent publication of a Notice in the Government Gazette regarding the establishment of a Advisory Committee to the Minister of Health on the NHI is worrying as it basically excludes the private medical sector from the committee.

Documents from the ANC that have been leaked to us as well as documentation on the ANC website and reports from the Minister of Health, Aaron Motshoaledi and participation in the Big Debate on eTV has given us some indication of where the ANC is planning to move with the NHI.

The proposals so far indicate either the total abolition of all Medical Schemes and the creation of a National Health Insurance Fund, managed by the Government through the Department of Health or some form of medical scheme industry with only top up cover. The plans suggest the implementation of a basic benefit package of care that every person in South Africa shall be entitled too. Some of the documentation, now said to be re-worked by the ANC, suggest a minimal role of Medical Schemes whereby some wealthy individuals would be able to buy some services from Medical Schemes not supplied by the NHI. This would include some dentistry and plastic surgery. The documents do not speak about the existence of the private sector next to that of a public sector.

The basic problem though still remains: The Government simply does not have the ability to deliver services. We are deeply concerned about the sustainability of the private sector if payment needs to be managed by a government agency, state department or semi-state organisation. The track record of payment and management by these current systems i.e. ESCOM, SAA, SABC, COID (WCA), RAF (Road Accident Fund), Public Sector Hospitals, HIV role out, etc. speaks for itself.

The DoH has also indicated that it wants to control and own the National Procedural Coding Structure of Medical Professionals. If this has to happen, the work done in the NHI (in the private and public sectors) would be heavily regulated by the DoH. New technology, treatments, medication etc. would then simply not be available in South Africa.

The PsychMG and the SAPPF are in the process of drafting a new National Procedural Coding Structure of international standard and has joined the Private Health Informatics Standards Committee (PHISC) to set the standards of the new coding structure. All medical schemes, pharmaceutical companies, switching houses, hospital groups and other professional organisations are members of this organisation. The DoH is now communicating and intimidating other role players not to be part of this process as they want to control this process.

The threats to the private sector are clear.

The PsychMG has thus joined the other professional organisations to protect the interests of the private sector as well as to strengthen and empower the SAPPF.

PsychMG MEMBERSHIP

We urge all Psychiatrists to join PsychMG.

As a member of the PsychMG, members would also be members of SASOP and SAPPF, as membership fees will be paid by PsychMG.

The membership fee would be R1000-00 per month and will be utilised as follows:

• R1500-00 SASOP Membership fee for 2010
• R1000-00 SAPPF Start up fee - 2009 only
• R2500-00 SAPPF Membership fee for 2010
• R1200-00 PsychMG Membership fee to cover sundry costs
• R1800-00 Management fee (Healthman)
• R3000-00 Legal fees (R1500 for NHRPL and R1500 for NHI and other)
• R1000-00 Project fees (actuarial services, cost studies, procedural coding etc)

Our alliance with Healthman has been very productive and has also been very beneficial as expertise are needed regarding cost studies, medical scheme matters and matters pertaining to legal issues, communication and information regarding NHI and coding structures.

The annual cost study cost is included in the fee as we have to present a cost study yearly in terms of the National Health Act.

As we move towards the introduction of the NHI, we would need input from actuarial firms to advise on alternative re-imbursement models and cost of practice. We expect to be involved in several legal battles as this seems the only way to deal with the DoH and others in government.

The involvement of everybody with an interest in private practice is asked and an appeal to join the PsychMG is urgent. We thank those who have already joined the PsychMG.

We realise that the cost increase is huge, but it seems as if there is no other way forward. The directors of the PsychMG are not remunerated for the work done, but have to spend days out of practice to be involved with meetings and information sessions around all the issues raised. As the cost is enormous to them individually, time cannot be wasted to also be running around to find funds to cover basic costs to address these serious issues.

The payout to Psychiatry has increased from R154 million in 2005 to R295 million in 2008, an average increase of 30,51% per annum. Most of this increase was attributable to the efforts of PsychMG, P3 and the office of HealthMan.

If you have any questions please do not hesitate to contact the PsychMG Board Members for more information:

To join PsychMG please complete the attached documentation and fax back to 011 782 0270.

• ACB Authority Form
• Share Application Form

Kind regards

EUGENE ALLERS

CHAIRPERSON