Negotiate healthcare tariffs: Sama

2011-11-08 13:15

kalahari.com

Johannesburg - Medical schemes should be able to negotiate tariffs with hospitals, clinics and doctors, the SA Medical Association (Sama) said on Tuesday.

It was reacting to a court ruling that medical schemes should pay for conditions in full which are covered under the prescribed minimum benefits (PMB), rather than up to the scheme tariff.

PMBs are the minimum level of diagnosis, treatment and care that a medical scheme is obliged by law to cover.

Sama chairperson Dr Norman Mabasa welcomed the ruling from the North Gauteng High Court, but said it was an issue that should never have ended up in court.

"This was not a misunderstanding of the PMB rules," he said, "but a development that can be directly attributed to absolutely no mechanism being available for providers and schemes to negotiate on tariffs and possible issues surrounding them."

Revisit tariff negotiation

He said he hoped medical schemes would join Sama in lobbying for a Competition Commission ban on health tariff negotiation to be revisited.

On Monday, the court ruled that PMB, which protect members of medical schemes, would remain in place.

The Board of Healthcare Funders (BHF) had asked the court to rule on regulation eight of the Medical Schemes Act 131 of 1998. The regulation states that medical schemes must pay for the diagnosis, treatment and care of all PMB conditions in full, or at the price charged by the healthcare provider.

The scheme must pay for all PMB conditions in full and from its risk pool, not from a clients' savings account. These benefits include 270 serious health conditions such as tuberculosis and cancer, any emergency condition, and 25 chronic diseases, including epilepsy, asthma and hypertension.

In court, the BHF represented a number of medical schemes and administrators. It was later joined by the SA Municipal Workers' Union national medical scheme.

In a statement on Tuesday, the BHF said it was disappointed that the merits and principles of the matter had not been considered by the judge.

Technical points

"There is therefore still no judicial pronouncement on the correct interpretation of regulation eight," the organisation said.

"Essentially, the judgment upheld the technical points raised by the respondents and the case was dismissed on the basis that BHF, as an industry body, lacks the necessary standing to have brought this matter to court."

It would consider the judgment and its legal options, and would also seek a meeting with Health Minister Aaron Motsoaledi.

The Council for Medical Schemes, the first of 13 respondents in the case, welcomed the ruling on Monday.

"Prescribed minimum benefits are a cornerstone of the Medical Schemes Act and they were included in legislation for a good reason: to protect beneficiaries against unforeseen ill health that may prove financially catastrophic for them," council CEO Monwabisi Gantsho said. Gantsho is also the registrar of medical schemes.

"As the regulator tasked with looking after the best interests of medical scheme beneficiaries, we are happy that our courts have confirmed the need for such protection in law."
- SAPA
Read more on:    sama  |  norman mabasa  |  health
NEXT ON NEWS24X
SHARE:

Read News24’s Comments Policy

24.com publishes all comments posted on articles provided that they adhere to our Comments Policy. Should you wish to report a comment for editorial review, please do so by clicking the 'Report Comment' button to the right of each comment.

Comment on this story
4 comments
Add your comment
Comment 0 characters remaining
 

Inside News24

 
/Music

Jobs in Cape Town [change area]

Property [change area]

Travel - Look, Book, Go!

Magical Massinga

Spend 5 nights at the gorgeous Massinga Beach Lodge in Mozambique and only pay for 4 from R13 220 per person sharing. Includes return flights, accommodation, transfers and romantic turndown. Book now!

Kalahari.com - shop online today

Up to 40% off fashion accessories

Save up to 40% on selected handbags, purses, watches, jewellery and more. Offer valid while stocks last. Shop now!

Save up to R2000 on top electronics

Get every day mind bowing savings on top electronics. Offer valid while stocks last. Shop now!

As seen on TV - New book releases at only R199 each

Get mind blowing book savings on new titles. Offer valid while stocks last. Shop now!

Save up to 50% on Women’s month treats!

Celebrate the awesome women in your life with awesome treats like beauty products, fashion accessories, bestselling books, electronics and more. Offer valid while stocks last. Shop now!

Up to 60% off - clearance sale!

Save up to 60% on appliances, books, electronics, toys, movies and more. Offer valid while stocks last. Shop now!

OLX Free Classifieds [change area]

Samsung Galaxy s4

Mobile, Cell Phones in South Africa, Western Cape, Cape Town. Date October 24

Best bargain in big bay

Real Estate, Houses - Apartments for Sale in South Africa, Western Cape, Cape Town. Date October 25

VW Golf 6, 1.6 Trendline (Excellent condition)

Vehicles, Cars in South Africa, Western Cape, Cape Town. Date October 25

Horoscopes
Aquarius
Aquarius

The quest for understanding has reached a new intense emotional level. The more tempestuous your emotions are, the bigger the...read more

There are new stories on the homepage. Click here to see them.
 
English
Afrikaans
isiZulu

Hello 

Create Profile

Creating your profile will enable you to submit photos and stories to get published on News24.


Please provide a username for your profile page:

This username must be unique, cannot be edited and will be used in the URL to your profile page across the entire 24.com network.

Settings

Location Settings

News24 allows you to edit the display of certain components based on a location. If you wish to personalise the page based on your preferences, please select a location for each component and click "Submit" in order for the changes to take affect.








Facebook Sign-In

Hi News addict,

Join the News24 Community to be involved in breaking the news.

Log in with Facebook to comment and personalise news, weather and listings.