Healthcare board seeks clarity on minimum benefit schemes

2011-05-10 00:00

THE Board of Healthcare Funders (BHF) has filed court papers seeking clarity about the payment rates of prescribed minimum benefit (PMB) conditions by medical schemes and doctors.

PMBs were first promulgated by the Medical Schemes Act of 1998 and cover a range of medical conditions that would negatively affect the lives of patients if left untreated. These include 25 chronic conditions such as hypertension, diabetes and asthma.

The head of corporate communications at the BHF, Heidi Kruger, said the act forces medical schemes to cover the full cost of diagnosis, treatment and care for members.

“The problem at hand is that government had scrapped the tariff guideline for service providers and that left doctors and medical schemes charging patients with PMBs whatever they like,” said Kruger.

“The act says medical schemes should pay whatever doctors charge and that leads to high premiums for scheme members.

“This creates an open-ended liability for patients and medical schemes, and is clearly not in the interest of the patients.”

Kruger said the BHF further urges the government to establish the proposed pricing negotiating chamber so that medical tariffs are fair and reasonable to the provider and its scheme members.

Kruger said that hospital costs have increased by 75% over the last 10 years and specialist costs by 59% as a result of the profit motive and lack of tariff framework to contain costs within the private healthcare sector.

Claims paid out by medical schemes in 2009/2010 outweighed member’s contributions by R2,5 billion, she said.

“Schemes have been forced to dip into their reserves to pay claims as a result. Because of this situation, members have to fork out more and more for their medical scheme premiums, and if this continues only the rich will have access to private healthcare,” she said.

Council for Medical Schemes communication manager Aleksandra Serwa said the matter is sub judice as it has not been brought before the court.

The council regulates medical schemes.

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