The South African Medical Association (SAMA) is no longer allowed to publish a recommended tariff (previously the SAMA Rand value) in its annual Guide to Billing (GTB) for medical services. The reason for this is that the Competition Commission decided that SAMA was contravening the Competition Act of 1998, which prohibits the setting of purchase or selling prices among those in a competitive relationship.
Subsequently the Competition Commission instructed the Department of Health and the Council for Medical Schemes (CMS) to compile a National Reference Price List for Health Services (NRPL - HS). It was agreed that this list would be based on the items, descriptors and units of the SAMA GTB, to which a Rand value would be added.
The GTB will include the SAMA codes, descriptions and the units, but not an amount. With this information doctors will be able to work out a rand conversion factor to determine an appropriate fee for private patients, which can be higher, lower or equal to the National Reference Price List.
This means that doctors would be allowed to charge whatever professional fee they can justify. Patients will be billed for the difference between the medical scheme benefit and the professional fee that doctors would generally charge for their services.
Medical schemes will determine the level of benefits they are prepared to pay for services rendered. This amount could be equal to, higher or lower than the National Reference Price List.
It was agreed that the CMS would distribute the National Reference Price List to medical schemes and administrators. This list will not be published but would only be available in a PDF or read-only format.
SAMA will continue to publish its 2004 GTB, which will include the National Reference Price List and the injury-on-duty (COIDA) VAT-inclusive amounts. The Compensation Commissioner will not publish its structure in a Government Gazette as before, and will only make this information available on its website.
In light of the above, SAMA's GTB would be the only printed publication for doctors. The BHF may not publish a Recommended Scale of Benefits.
|An entry in the 2004 GTB* would look as follows:|
|Code||Descriptor||SAMA Units||NRPL amounts||COIDA amounts|
|* Please note that this is only an example and not based on actual information.|
|SAMA is the only distributor of the GTB incorporating the NRPL-HS|
|Member price||R257.00 (subsidized price)|
|Institutions and Prisons||R550.00|
|All other buyers||R771.00|