05 December 2008

Medical costs simplified

The Health Professions Council of South Africa has decided to scrap the ethical tariffs. Read why this should help empower consumers.

The Health Professions Council of South Africa (HPCSA) has decided to scrap the ethical tariffs used by doctors as a ceiling for patient accounts.

There have always been two sets of tariffs – the National Health Price Reference List (NHPRL) until recently issued by the Board of Healthcare Funders, and now by the Department of Health, and the HPCSA tariffs, which tended to be much higher.

“The HPCSA ethical tariffs were previously used to guide us in determining whether a practitioner had over-charged a patient,” explained HPCSA Registrar, Advocate Boyce Mkhize. “However, the Department of Health’s new processes around the NHRPL which embraces all healthcare players within the country, eliminate the need to determine our own tariff, which has historically been three times higher than the NHRPL.”

Whereas the scrapping of a price reference list three times higher than the NHRPL certainly is good news, new transparency guidelines may make an even greater impact.

Essentially, health care providers will now have to tell you what the NHRPL price or your medical scheme's price for a particular procedure is. They can still charge more than that, but they will have to make it clear to you by exactly how much they are charging more than the recommended NHRPL price or medical scheme price.

Being over-charged?
As a regulatory body protecting the public consumers of healthcare services, the HPCSA will still retain its authority to determine whether a practitioner has overcharged a patient.

In order to make this determination, the HPCSA has adopted the following principles:

  • a practitioner shall charge a non-insured patient the NHRPL rate except where the patient provides written informed consent for a billing higher than the NHRPL rate, and any charge above the NHRPL rate without the patient’s consent shall be deemed to be overcharging;
  • a practitioner may charge a private-paying insured patient a rate payable by the Medical Scheme in which that patient belongs, or is a member, if it is higher than the NHRPL rate, provided that any rate higher than the rate payable by the Medical Scheme shall be deemed to be overcharging, except where the patient has given written informed consent for a charge higher than the Medical Scheme rate; and
  • for the purposes of determining whether the patient has provided informed consent, the practitioner is required to indicate to the patient the prevailing NHRPL or Medical Scheme rate for whatever procedure the patient presents for, as well as the difference between that rate and the rate the practitioner intends to charge, as well as the amount that the patient may have to pay in addition to the stipulated rate.

In essence, the above means that healthcare providers will have to get your consent for whatever premium they charge above the NHRPL or medical scheme prices. In other words, consent equates to acknowledging that you are being charged a higher price, and agreeing to pay this higher price.

"It is a matter of transparency to enable patients to determine if they are being overcharged, and to know in advance what the costs will be and how their pockets will be affected," says Bertha Peters-Scheepers, Senior Manager: Public Relations and Service Delivery at the Health Professions Council of South Africa.

If the patient refuses to consent to paying a higher rate, the healthcare provider could refuse to service a patient at a lesser rate, and of course the patient can seek the services of another health care provider, says Peters-Scheepers. "However in an emergency situation the healthcare provider cannot refuse to treat a patient."

Move welcomed by BHF
The scrapping of the ethical medical tariff was welcomed by the Board of Healthcare Funders of Southern Africa (BHF) who said it would reduce South Africans' confusion at the point of healthcare services.

"It has long been the argument of the BHF that the publication of a 'ceiling' tariff by the [Health Professions' Council of South Africa] has contributed to the cost spiral in health care," it said in a statement.

The Board believed the decision would empower consumers to make informed decisions on the cost of healthcare procedures and consultations, and in deciding whether they should pay if the costs exceeded medical scheme tariffs.

"BHF fully supports the National Health Reference Price List (NHRPL) process which is based on true costs of providing healthcare services, and therefore represents fair and reasonable costs," said spokeswoman Heidi Kruger.

The scrapping of the ethical tariffs will only come into effect once the NHRPL rates for 2009 have been adopted following a consultative process with stakeholders. This is expected to happen in mid-December.

The HPCSA will investigate complaints from the public where they have been charged over and above the NHRPL rate or Medical Aid rate without having provided written consent. Complaints can be lodged at email: or the HPCSA Client Call centre tel: 012 338 9300/1.

- (Marcus Low, Health24/Sapa, December 2008)

Source: Press release from the Health Professions Council of South Africa.

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