Secondary

Private Practitioners take on Genesis

TimesLIVE reports that the medical aid scheme’s attempt to reduce the amounts payable for prescribed minimum benefits met with resistance from the SA Private Practitioners’ Forum who claimed that the scheme’s financial statements show that it is not being subjected to ‘ruinous claims’ for the conditions.

The Forum said the fact that the scheme’s reserves were 540% higher than the legal requirement showed that it was ‘not exposed to potential bankruptcy due to uncontrolled expenses’. The forum said there was little ‘tangible evidence’ that hospitals and doctors were exploiting the ‘payment in full’ provision. The Minister of Health has not opposed the Genesis application, and his department had introduced a draft law that would remove payment ‘in full’ from the regulations. The new law would have medical aids cover the minimum benefits based on a 2006 price list.

…the specialists’ forum warned that, if the draft law were enacted, or Genesis won its case, consumers would have ‘limited access’ to healthcare.

Forum CE, Dr Chris Archer said there was little evidence that the current regulations were harming medical schemes since they allowed schemes to take steps to manage their financial risks. Schemes were permitted to set up networks of healthcare providers that charged agreed rates, and could limit their medicine costs by limiting patients’ lists of approved drugs.

Legalbrief Today reported on a Business Day article which states that Genesis’s Chief Executive, Brian Watson, responded by saying that the high reserves were due to its membership base being younger, resulting in less claims than in a scheme with an older and sicker membership profile. Forum CE, Dr Chris Archer, said there was little evidence that the current regulations were harming medical schemes since they allowed schemes to take steps to manage their financial risks. Schemes were permitted to set up networks of healthcare providers that charged agreed rates, and could limit their medicine costs by limiting patients’ lists of approved drugs.

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