1. HPCSA TARIFF GUIDELINES
Perspectives of the
South African Dental Association
22 August 2012

2. SADA and Oral Health in South Africa
CONTEXTUALISATION
SADA and Oral Health in South Africa
SADA representative of 80% of dentists in SA R2 billion industry Private practice employs – people in SA 40% exit ratio from the profession High incidence of depression Oral health perceived as not life-threatening and therefore not a funding priority Exceptionally low acknowledgement (patients, statutory, funders) about high input costs in private practice Medical schemes contributions reduction – from 8.4% to 2.4% Low access and low consumer awareness Brain drain high

3. Scenarios for Dentistry in South Africa
10% 2% 3%
85%

4. WHY DOES ORAL HEALTH MATTER?
Oral Health and the Burden of Disease
Oral health is an essential component of general health
HIV/AIDS:
Oral manifestations often facilitate diagnosis and identification of individuals who may be HIV positive
Non-communicable diseases:
Dental caries recognised as a major non-communicable disease (FDI, WHO, UN)
Growing evidence of association between periodontal disease and diabetes, heart disease, strokes and respiratory ailments.
Oral cancer (affecting younger population, poor prognosis)
Injury and violence:
most physical injuries resulting from family violence are found on the face, head, neck and oral areas that are clearly visible to the dental team during examinations

5. CONCERNS WITH THE HPCSA TARIFF GUIDELINES
Not within the mandate of the HPCSA to publish a tariff
Ultra vires section 53 of the HPA (fees referred to in Sec 53(3)(d) are not a tariff for supply of professional services by healthcare professionals and cannot be used as a basis for determination of any tariff;
Contravenes the provisions of the Competitions Act (represents a fee that should be charged in order to be accepted by medical schemes, thus facilitating convergence)
Procedural concerns
No meaningful engagement – limiting right to fair administrative justice as per Sec 33 of Constitution and Sec 3 of Promotion of Administrative Justice Act;

6. CONCERNS WITH THE HPCSA TARIFF GUIDELINES
Flawed basis for preparation of the guidelines
Not reflective of any reasonable cost - based on a the 2006 RPL, which related to medical scheme benefits and not to professional fees; 
30-40% less than approved professional fees in 2006
Inflated by CPI (refer exchange rate fluctuations and increases in utilities); materials included in codes and therefore increasingly skew
The 2006 list is 6 years old in terms of procedures and technology.
Affecting dignity of the professional and patient

8. RECOMMENDATIONS
Immediate withdrawal of the HPCSA tariff guidelines (incl website)
Immediate implementation of a cost study through a process approved by all stakeholders
Recognition of the specific challenges in dentistry and constructive engagement with the profession to address risks

9. THANK YOU