General Practitioners Dr BH Modi (MBChB, MCFP, ABM) Johannesburg City Medical Group The BHF Southern African Conference 22-25 July’07 Sun City
“Monopsony: Break provider’s backs by pushing prices down too low (i.e. GPs) Andrew Myburgh (BHF 2007) The BHF Southern African Conference 22-25 July’07 Sun City
Agenda Provider Needs Professional Issues Medical Aid Benefit Design Economics Practice Administration Way Forward The BHF Southern African Conference 22-25 July’07 Sun City
Provider Needs Clinical Independence Fair Reimbursement Individual versus Utilitarian system The BHF Southern African Conference 22-25 July’07 Sun City
Professional Issues HPCSA / DOH Direct access for patients to specialists Family Physician as a specialist qualification Doctors cannot employ other professionals and bill for their services, e.g. nurses Emphasis on Disciplinary Hearings Reactive rather than Proactive Guidance to the profession, e.g. Clinical Protocols The BHF Southern African Conference 22-25 July’07 Sun City
Benefit Design Insurance based, catastrophic cover Lack of Primary Care – emphasis on cure Illogical rules Savings account for out-of-hospital - Restriction PMB conditions – retrospective Top – Down Approach The BHF Southern African Conference 22-25 July’07 Sun City
Economics Patient Dilution Benefit Design High Non-Healthcare Costs Inadequate reimbursement Collective Bargaining Fraud Reversal of Payments Dispensing Fee The BHF Southern African Conference 22-25 July’07 Sun City
Practice Administration 131 Medical Aid Schemes + options Rules and Regulations – Admin nightmare ICD10 codes PMB conditions 25 CDL conditions and 270 DTPs Laws, Ethical Rules & Regulations Patient Confidentiality The BHF Southern African Conference 22-25 July’07 Sun City
Way Forward Collaboration between HPCSA / DOH and GP groups (IPAs) Collaboration between Schemes & GP groups (IPAs) Manager of Resources Basic Benefit Package – Primary Care Simplify Reimbursement Models Risk Taking and Risk Sharing Value for Money The BHF Southern African Conference 22-25 July’07 Sun City
Thank you The BHF Southern African Conference 22-25 July’07 Sun City