Medical Tariffs in SA affected by this court ruling


I hope you understand this:

FOR IMMEDIATE RELEASE

08 November 2011

Regulation 8 ruling should prompt new era of tariff negotiation – SAMA

 While welcoming the North Gauteng High Court ruling that Regulation 8 of the Medical Schemes Act (131 of 1998) – that medical schemes must pay in full for all PMB conditions – SA Medical Association (SAMA) chairman, Dr Norman Mabasa, has again stressed that the Competition Commission ruling banning medical schemes and provider groups from negotiating tariffs should be revisited.

“We have spent a lot of time and effort supporting the Council for Medical Schemes (CMS) in its defence of Regulation 8,” said Mabasa when commenting on the ruling which came as a result of the Board of Healthcare Funders (BHF) asking the court to pronounce on it almost a year ago. The BHF was later joined by the SA Municipal Workers Union National Medical Scheme in seeking to have Regulation 8 interpreted to mean that schemes must pay for PMB conditions only up to the scheme tariff, effectively changing the meaning and purpose of the PMB provisions in the Act.

“Yes, it is a victory for the CMS, for those of us who backed the CMS cause, and particularly for medical scheme members, but this is another one of those issues that should never have ended up in court,” Mabasa added.

“This was not a misunderstanding of the PMB rules,” he explained, “but a development that can be directly attributed to absolutely no mechanism being available for providers and schemes to negotiate on tariffs and possible issues surrounding them.

“We hope that the medical schemes will now join SAMA in pushing for a new era when provider groups and funders can engage positively on pricing requirements,” said Mabasa.


END

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