It’s now an old cliche that times are a changing, but one thing that doesn’t change and in fact is expected in South Africa is the annual price increase. In Optometry, as in all medicine disciplines, all our suppliers diligently send out their notice of ‘Price Increases for 2011’ the moment the Post Office came back in service from its New Years break.

Unfortunately the same can’t be said from our ever more confusing Medical Scheme arena and specifically when it comes to Medical Scheme Tariffs. When Government in 2007, unilaterally took over the setting and management of the National Health Reference Price List (NHRPL), a process that normally involved some serious negotiations between service providers (medical fraternity), individual schemes and their 3rd party administrators, everything came to a standstill.

The unilateral price setting of the NHRPL by Government was seen as unconstitutional and in most cases the fees set by Government was financially unsustainable for the Service Providers and many Providers feared for their lively hood.

As case and point you only have to look at your local Pharmacy where Government did succeed in regulating Pharmacy Fees and as a result many hundreds of Pharmacies closed their doors.

Taking cognisance of these facts and after failed negotiations with the Government around the issue of the NHRPL it was decided to take the whole matter to the high courts of South Africa.

Now in 2011 the whole NHRPL matter is still in stalemate, which unfortunately leaves a lot of confusion and frustration in its wake as there is no set Medical Aid Tariff Guidelines as can be seen by this letter issued by the Board of Health Care Funders (BHF).

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Dear Health Service Provider,

BHF would like to take this opportunity to wish you a happy and prosperous 2011.

We expect that 2011 will once again be a challenging year as we endeavor to address the many issues plaguing the private healthcare industry in SA.

As you know, the RPL 2007 – 2009 was set aside by a High Court Judge in July 2010. Furthermore, a tariff list of 2011 has not been published. In view of this, there is currently much uncertainty around tariff increases for 2011 and BHF has been inundated with requests for clarity in this regard.

In order to assist healthcare providers in this respect, we attach an extract from the circular (CMS Circular 67 of 2010) to medical schemes from the Council of Medical Schemes which refers to the issue of tariff increases for 2011.

Bullet point three provides a guide to medical schemes regarding the increase for professional services for 2011.

Should you wish to view the circular in its entirety, it is available on the following link: http://www.bhfglobal.com/files/bhf/MC10-79 Circular67Of2010.pdf or on the CMS website www.medicalschemes.com.

Yours Sincerely,

Eunica Guvakuva

The Board of Healthcare Funders of Southern Africa

PCNS: Finance Administrator

Tel: 011 537 0268

Fax: 086 607 3988

e-mail: LynetteS@bhfglobal.com
website:www.bhfglobal.com

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The result for the person on the street is no set Medical Tariffs. This means Medical Schemes are open to pay as much or as little as they personally deem viable for any set medical product or service. So the next time you walk into your Medical Service Provider’s rooms please keep in mind that there is no more such a thing as a ‘Medical Aid Price’, as each different scheme has it’s own unique price determined by it’s board of trustees. They now have the freedom to determine their own tariffs, negotiate their own packages of services and limit your access to only certain service providers, usually chosen on a financial basis.

The responsibility now lies with the patient to know what benefits they have with each scheme and perhaps shop around to see with what scheme they receive the best benefits for their monthly contributions.

Times sure have changed!