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News Article : I found your article on the court ruling regarding PMBs to be misleading
Category: Healthcare Insurance : Medical Schemes
Author:Heidi Kruger
Email:[email protected]
Posted:08 Nov 2011

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The uncertainty with regards to pricing of healthcare will be allowed to continue

The case was dismissed because the Judge ruled that BHF, the representative body, did not have locus standi and therefore the judgement did not go into the merits of the matter at all.

Therefore, the purpose of the hearing, which was to obtain a Declaratory, was not fulfilled.

Essentially, Judge Pretorius, in her judgement, has upheld the points in limine, and dismissed the case on the basis that BHF, as an industry body and therefore not directly affected by the outcome, lacks locus standi.

The status quo therefore remains.  We believe that this is bad news for consumers, as the uncertainty with regards to pricing of healthcare will be allowed to continue.

We believe that this judgement may negatively affect the sustainability of medical schemes, which have been under severe financial pressure due to the opportunistic and reckless charging by some healthcare providers for Prescribed Minimum Benefits. 

We are concerned that medical scheme members will be negatively affected as their schemes will continue to be subjected to an open ended liability and may have no choice but to raise contribution premiums.

After all, a scheme is a 'stokvel', which collects money from consumers and pays the money out on healthcare benefits, etc. 

Over the past few years, all healthcare pricing guidelines have been scrapped, thereby causing costs within the sector to increase. This situation is almost unique in the world, i.e. where there are no tariffs for healthcare services.   

The Minister of Health has cited spiraling costs in the private sector as one of the reasons to usher in NHI.

Therefore, this judgement and the current behavior by some providers is simply reinforcing the need to regulate costs relating to healthcare services. 

The current unruly nature of charging for healthcare is undermining the reforms being proposed by government to make healthcare more accessible, equitable and affordable.

The BHF will engage the Minister of Health on the matter and urge that government steps in to assist the private funding sector to contain costs related to healthcare services.

The BHF will also urge government to establish the proposed Pricing Negotiating Forum so that the tariffs which are paid are fair and reasonable both to the provider and the medical scheme member.

We believe that the judgement could have paved the way for NHI in initiating a shift of  mindset from having no limits on charges to a situation where providers and funders will have to agree on charges to protect the consumer.

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Healthcare Insurance - Medical Schemes
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