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News Article : SAG Response to SAMA
Category: Healthcare Insurance : Medical Schemes
Author:Edited by ITInews
Email:[email protected]
Posted:29 Aug 2007

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Reduce the power of administrators

Statement by the South African Medical Association’s (SAMA) Specialist Private Practice Committee (SPPC) dated August 24 2007 entitled: Dispute Between Discovery Health and the Specialist Advocacy Group

The SAG is very concerned about the overall cost of access to private health and the quality of the care patients of its specialists members receive.

Accordingly, the SAG looks beyond the clinical specialist segment at the bigger picture in its advocacy role on behalf of the patient.

The continuing erosion of medical scheme benefits, ever increasing premiums and the high amount of scheme expenditure on non-healthcare costs are of particular concern. 

“The SAG recognises medical schemes as the only entity with which to engage on matters affecting patient care and the cost thereof."

"This approach is consistent with the provisions of the Medical Schemes Act under which trustees of medical schemes are required to act in the best interests of scheme members, independently of administrators and any other segment of the healthcare industry.” Says Prof. Chris Joseph, Head of the SAG.

The SAG does not recognise the administrator as the entity with which to engage on matters affecting patient care and cost thereof.

The SAG fully supports the SAMA statement that encourages provider-funder engagements if conducted in a transparent manner.

However, the SAG fails to see how such engagement can be conducted transparently with administrators that are not responsible for the cost or quality of patient care and make money from selling administration and passive managed care services to medical schemes.

In the interests of the patients of specialist members of the SAG, the SAG will not waiver in its determination to engage with the trustees of medical schemes directly.

“We believe that the approach taken by the SAG in dealing directly with schemes and thereby bypassing administrators will significantly reduce the power of administrators and it is understandable that administrators will fight this move.

However, the SAG is not prepared to compromise the standing of the patients of its specialist members any longer by dealing with the wrong segment in the industry” said Prof. Joseph.

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