Roy Watson's Column

 

Hospital tariffs don’t reflect spirit of affordable access

The proposed private hospital tariffs for 2008 do not reflect a spirit of working towards a national health system that provides reasonable and affordable access to all South Africans, health minister Dr Manto Tshabalala-Msimang noted in response to the private hospitals’ proposed tariff increases of between 8% and 33%.

“I had hoped that the Indaba (the multi-stakeholder forum on private health care costs convened by the ministry in September last year) would have at least sensitised the private health care sector to our concerns about escalating costs,” Tshabalala-Msimang added before appealing to the hospital groups not to implement the proposed price increments “until we have discussed this matter with them”.

Doctors react badly to recommended 5,4% fee hike

Medical practitioners have reacted badly to their recommended 5,4% fee increase for 2008 claiming that, not only is it below the 7,3% inflation rate, but also below the 7,5% increase given to public sector health care workers last year.

According to media reports, the proposed increase – published in the 2008 National Health Reference Price List (NHRPL) at the end of last year – was seen as a “slap in the face” by SA Medical Association (SAMA) private practice head, Dr Monwabisi Gantsho. It failed to take into account practice running costs and SAMA CEO, Dr Kgosi Letlape, has reportedly claimed that the fee proposed would result in private practitioners earning less than their public sector counterparts.

NHRPL 2009 notice set for early publication

The notice calling for National Health Reference Price List (NHRPL) 2009 submissions from all stakeholders is likely to be published in the Government Gazette as early as January, departmental health finance and economics manager, Siyabonga Jikwana indicated in a year-end interview.
Providers and other stakeholders, he said, would be given “three to four months” to formulate their data “with the help of independent consultants”.

He added that he did not anticipate the delays experienced in the publication of previous lists, but did concede that there would be challenges “as is always the case with issues pertaining to costs and tariffs”.

Fixing doctor prices would inflate costs

If doctor prices were to be fixed, their reaction would result in higher costs to patients, healthcare actuarial consultant, Barry Childs, warned at a recent risk management seminar.

Doctors would definitely react to a drop in their top line because of the large drop effect it would have on their bottom line. To explain this, Childs said that if the fixed price meant a 10% drop, they, the doctors, would compensate with a 10% increase in utilization.

An individual doctor’s costs, however, was not the only factor. As Childs pointed out, when doctors work they generate costs at least five times their own costs. In the context of reacting to a 10% drop with a 10% utilization increase, therefore, this would result in an additional cost of 55% more than that which would have been reflected in the original bill.