PRESCRIBED TARIFFS AND/ OR FREE MARKET FEES FOR PSYCHOLOGISTS? Facilitators: Dr Theo H Veldsman Dr Louise Olivier

SERVICE CATEGORIES CATEGORY 1: TARIFFS CATEGORY 1: TARIFFS Services rendered by any registered psychologist to individuals. Responsibility for fee and contractual relationship is with individual, most often in one-on-one therapeutic relationship. Fees can be claimed from medical schemes. Services rendered by any registered psychologist to individuals. Responsibility for fee and contractual relationship is with individual, most often in one-on-one therapeutic relationship. Fees can be claimed from medical schemes..

CATEGORY 1: TARIFFS Assumptions Medical model of standardised service provided in prescribed manner to individual/ group who can claim expense back from medical scheme Medical model of standardised service provided in prescribed manner to individual/ group who can claim expense back from medical scheme Relatively uninformed, non-professional person, the client, with little negotiation power who needs to be protected against possible professional abuse. Relatively uninformed, non-professional person, the client, with little negotiation power who needs to be protected against possible professional abuse. Review governance structures exist within the client-professional situation: Health Professions Council and the clients own medical aid scheme Review governance structures exist within the client-professional situation: Health Professions Council and the clients own medical aid scheme

SERVICE CATEGORIES CATEGORY 2: FEES CATEGORY 2: FEES Services rendered by any registered psychologist to organisations (inc. companies) and/or groups. Responsibility for fee and contractual relationship is with organisation (inc. company) and/or group Services rendered by any registered psychologist to organisations (inc. companies) and/or groups. Responsibility for fee and contractual relationship is with organisation (inc. company) and/or group

CATEGORY 2: FEES Assumptions Psychologists operate in free market, highly competitive setting where fees are determined in competition with competing professionals and non-professionals, and through negotiations with clients. Market forces also affect variances in fees over time Psychologists operate in free market, highly competitive setting where fees are determined in competition with competing professionals and non-professionals, and through negotiations with clients. Market forces also affect variances in fees over time Typical vehicle to Psychologist-client relationship is client accepted proposal turned into legally binding contract between the Psychologist and organisation. Organisation is represented by manager(s) during negotiation with ratification of their recommendations by more senior management. During delivery, regular review sessions with client occur. Appeal process build into contract Typical vehicle to Psychologist-client relationship is client accepted proposal turned into legally binding contract between the Psychologist and organisation. Organisation is represented by manager(s) during negotiation with ratification of their recommendations by more senior management. During delivery, regular review sessions with client occur. Appeal process build into contract Services rendered/ solutions offered, with approach adopted and means of delivery, have to be scoped and rescoped each and every time for prospective clients in order to make them specific to unique client needs and accommodate significant organisational differences Services rendered/ solutions offered, with approach adopted and means of delivery, have to be scoped and rescoped each and every time for prospective clients in order to make them specific to unique client needs and accommodate significant organisational differences

CATEGORY 2: FEES Assumptions Services/ solutions offered by Psychologist are presented to market and clients as being uniquely different in content and/ or process, which affect fees that can be charged. Some approaches, methodologies and tools are legally protected, and not open to public scrutiny Services/ solutions offered by Psychologist are presented to market and clients as being uniquely different in content and/ or process, which affect fees that can be charged. Some approaches, methodologies and tools are legally protected, and not open to public scrutiny Standing of Psychologist on professional maturity curve and reputation, as well as situationally located fee determinants, have significant impact on fees that can be charged Standing of Psychologist on professional maturity curve and reputation, as well as situationally located fee determinants, have significant impact on fees that can be charged

NEED Best practice guidelines be developed by PsySSA to protect the public for submission to HPSC Best practice guidelines be developed by PsySSA to protect the public for submission to HPSC E.g. contracts with clients should include information about services rendered, expected outcomes, fees, recourse/arbitration E.g. contracts with clients should include information about services rendered, expected outcomes, fees, recourse/arbitration

RECOMMENDATIONS BY PSYSSA Category 1 Category 1 Annual tariffs as determined by Council for Medical Schemes (i.e., the National Health Reference Price List) should be used as basis to compute proposed professional ethical ceiling fees, as requested by the HPCSA Annual tariffs as determined by Council for Medical Schemes (i.e., the National Health Reference Price List) should be used as basis to compute proposed professional ethical ceiling fees, as requested by the HPCSA Fees computed on basis of fees suggested by Medical Association of South Africa. Suggested formula (3,2 times the fees suggested by the Council for Medical Schemes as the ethical capping tariff and PsySSA suggests a 3,5 times the fee suggested by the Council for Medical Schemes) Fees computed on basis of fees suggested by Medical Association of South Africa. Suggested formula (3,2 times the fees suggested by the Council for Medical Schemes as the ethical capping tariff and PsySSA suggests a 3,5 times the fee suggested by the Council for Medical Schemes) PsySSA is currently negotiating with CMS regarding issues of time decay and current two hours allowed for assessment work per day, as these principles are flawed in practice. Proposed ethical ceiling fees are subject to change, pending the outcome of these negotiations PsySSA is currently negotiating with CMS regarding issues of time decay and current two hours allowed for assessment work per day, as these principles are flawed in practice. Proposed ethical ceiling fees are subject to change, pending the outcome of these negotiations PsySSA suggests that post-doctoral level psychologists with 10 and more years of experience can charge maximum fee PsySSA suggests that post-doctoral level psychologists with 10 and more years of experience can charge maximum fee

RECOMMENDATIONS BY PSYSSA Category 1: Challenges Category 1: Challenges Annual national research on practice revenue and costs required by Medical Schemes to determine increases. As near as possible, every one has to complete otherwise information is not accepted as representative Annual national research on practice revenue and costs required by Medical Schemes to determine increases. As near as possible, every one has to complete otherwise information is not accepted as representative Negotiations with Board for Health Funders (BHF) to determine our piece of cake Negotiations with Board for Health Funders (BHF) to determine our piece of cake Correct use of ICD-10 codes, which is legally required, in order to enable Department of Health to gain insight into value of psychological services and patterns of mental health Correct use of ICD-10 codes, which is legally required, in order to enable Department of Health to gain insight into value of psychological services and patterns of mental health If conflict between PsySSA and HPC should arise, how does it gets resolved? If conflict between PsySSA and HPC should arise, how does it gets resolved?

RECOMMENDATIONS BY PSYSSA Category 2 Category 2 Fees should be determined in accordance with free market principle, where fees are negotiated with organisations (inc. companies) and/or groups on competitive basis Fees should be determined in accordance with free market principle, where fees are negotiated with organisations (inc. companies) and/or groups on competitive basis Recommendation is consistent with role of Competitions Board in encouraging competition and in line with practice followed for psychologists working in world wide in free economies Recommendation is consistent with role of Competitions Board in encouraging competition and in line with practice followed for psychologists working in world wide in free economies

RECOMMENDATIONS BY PSYSSA Category 2: Challenges Category 2: Challenges Determining Going rate in market for services/ solutions and points on professional maturity curve Determining Going rate in market for services/ solutions and points on professional maturity curve Where to locate myself on professional maturity curve, get fair view on my reputation Where to locate myself on professional maturity curve, get fair view on my reputation Scoping work correctly, and managing scope creep Scoping work correctly, and managing scope creep Protection against Fly by nights, claiming to offer same service/ solutions at same quality Protection against Fly by nights, claiming to offer same service/ solutions at same quality Power bias towards client Power bias towards client

Suggestions made during Workshop PsySSA chatline on web site on fees and tariffs PsySSA chatline on web site on fees and tariffs Peer review to determine where a person is on professional maturity curve, and hence fees/ tariffs person can charge, e.g. forensic work Peer review to determine where a person is on professional maturity curve, and hence fees/ tariffs person can charge, e.g. forensic work