Tariff guides for dentists, doctors issued

At the moment there is no government control over the fees charged in the private sector, so doctors and dentists can theoretically charge what they deem fit. In practice, many doctors and dentists have entered into contracts with medical schemes and charge patients rates determined by the schemes. Other practitioners charge higher rates.

The HPCSA has published a list of prices it believes are a fair rate for consultations and procedures provided by doctors, specialists and dentists, said spokeswoman Bertha Scheepers.

"It is hoped that this new guideline will empower patients to understand what they will be charged for medical and dental treatments or procedures in a transparent manner, and provide clear guidance for practitioners so that patients will not be caught unawares with a high bill and claim the practitioner acted unethically," she said.

At the moment there is no benchmark against which the HPCSA can assess patient complaints about being overcharged. This is because the HPCSA scrapped its "ethical tariff" guidelines in 2008, which were in effect a set of maximum prices.

In 2010, the North Gauteng High Court ruled that a guide used by the medical schemes industry to determine reimbursement rates - the National Health Reference Price List - was invalid.

"In other words, there is a vacuum," said Scheepers. "The risk associated with this vacuum is that the HPCSA ... is unable to adjudicate or mediate on these complaints due to lack of a legally determined guideline tariffs."

The HPCSA's tariff committee used the 2006 National Health Reference Price List, and adjusted it for inflation to devise the fees in the guidelines for this year.

It consulted the SA Medical Association, the South African Dental Association, the Board of Healthcare Funders, and SA's two biggest medical schemes, Discovery Health and the Government Employees Medical Scheme, said Scheepers.

She said the tariff guide was not intended to set a ceiling on what doctors and dentists could charge. "The council is cognisant of the fact that practitioners have a right to charge fees commensurate with a number of factors such as their area of expertise, market segmentation of their client base and the area in which they practice. However, the practitioner has a responsibility to inform the patient what he or she is charging patients, so that they can make an informed decision.

"They can then 'shop around' for the best price or decide they are willing to pay an amount higher than the tariff guideline by signing a consent form. It is important that the process of charging for healthcare services is transparent for both parties."

Source: Business Day via I-NET Bridge