1. General Practitioners
Dr BH Modi
(MBChB, MCFP, ABM)
Johannesburg City Medical Group
The BHF Southern African Conference July’07 Sun City

2. “Monopsony: Break provider’s backs by pushing prices down too low (i.e. GPs)
Andrew Myburgh (BHF 2007)
The BHF Southern African Conference July’07 Sun City

3. Agenda Provider Needs Professional Issues Medical Aid Benefit Design
Economics
Practice Administration
Way Forward
The BHF Southern African Conference July’07 Sun City

4. Provider Needs Clinical Independence Fair Reimbursement
Individual versus Utilitarian system
The BHF Southern African Conference July’07 Sun City

5. 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 July’07 Sun City

6. 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 July’07 Sun City

7. Economics Patient Dilution Benefit Design High Non-Healthcare Costs
Inadequate reimbursement
Collective Bargaining
Fraud
Reversal of Payments
Dispensing Fee
The BHF Southern African Conference July’07 Sun City

8. 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 July’07 Sun City

9. 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 July’07 Sun City

10. Thank you
The BHF Southern African Conference July’07 Sun City