1. Is the future sustainable? SpesNet Healthcare Director
Medical Specialists & Funders:
Is the future sustainable?
Dr Johan Oelofse
SpesNet Healthcare Director
The BHF Southern African Conference July’07 Sun City

2. What is a reasonable rate?
But before we talk Rates, Terms & Conditions ..
We first need to establish whether we, the specialists, want to contract with the funding industry
The BHF Southern African Conference July’07 Sun City

3. If in our shoes, would you contract with somebody who
Empowering Healthcare Delivery
through Informed choice
If in our shoes, would you contract with somebody who
.. continuously generalizes?
.. pays your money directly to patients, not to you?
.. reverses payments up to years later?
.. excludes some of your procedures or services?
.. imposes co-payments on your services?
.. discriminates against certain specialties and procedures?
The BHF Southern African Conference July’07 Sun City

4. If in our shoes, would you contract with somebody who
Empowering Healthcare Delivery
through Informed choice
If in our shoes, would you contract with somebody who
.. hasn’t got efficient IT systems and staff to manage PMB’s and ICD-10’s?
.. creates an administrative nightmare of 130 schemes and 350 plans?
.. imposes endless managed care systems?
.. does not share their benefit structures and managed processes with you?
.. ill-informs their patients about their rights and benefits; thereby putting the pressure on you?
The BHF Southern African Conference July’07 Sun City

5. If in our shoes, would you contract with somebody who
Empowering Healthcare Delivery
through Informed choice
If in our shoes, would you contract with somebody who
.. only applies portions of the market data?
.. accuses you of over servicing?
.. accuses you of over charging?
.. accuses you of being perverse?
.. accuses you of being the cost-drivers?
The BHF Southern African Conference July’07 Sun City

6. If in our shoes, would you contract with somebody who
Empowering Healthcare Delivery
through Informed choice
If in our shoes, would you contract with somebody who
.. name blasts you in the public eye?
.. challenges your clinical discretion?
.. denies you peer-peer discussions?
.. does quality assessment on you, your services and products you use without your involvement?
Somebody who just talks year after year?
The BHF Southern African Conference July’07 Sun City

7. What is a reasonable rate?
Empowering Healthcare Delivery
through Informed choice
What is a reasonable rate?
It is the substantiated fee
the professional deem he/she is worth
after taking the net effect
of the factors mentioned into consideration
The BHF Southern African Conference July’07 Sun City

8. Empowering Healthcare Delivery
through Informed choice
The way forward!
“.. if any one of you is without sin, let him be the first to throw a stone..
John 8:7
Start with:
Establishing trust in integrity and ability to deliver
Addressing the disease not the symptoms
Communication and more communication
Start walking, even if only a few steps!
The BHF Southern African Conference July’07 Sun City