CPC Qualicare / DocWeb | Doctor's Online resource for South African Doctors CPC Qualicare / DocWeb | Doctor's Online resource for South African Doctors
The official website of CPC/Qualicare IPA

August 2015 Newsletter

The BHF turns to Primary Health Care to preserve the Medical Aid industry

The recent BHF conference held at the CTICC in Cape Town last week represented a watershed in the history of the medical aid industry.

Practitioners were welcomed as members of the BHF and were actively encouraged to address the various sessions either from the floor in the form of questions, or from the podium during workshops with the industry.


I represented the PHC lobby on behalf of all IPA members through their groups affiliation with IPAF, and keenly explained the processes of Peer profiling, Peer mentoring, Peer management and Peer   Review, to the interested audience.  IPAF was well represented by Drs Nkosi, Prinsloo and Lison (Chair of CPC/Qualicare)

I drew their attention to the performance based reimbursement contracts which IPAF has with its   doctors for Medihelp, Bestmed, Polmed, Medshield, to perform their peer review on the peer profiled information from claims data analysis coming from the contracted practices. 

It is interesting to note that IPAF is currently completing a contract with Bankmed for peer profiling, and review, which also resulted in participating doctors earning  significant enhancements in their fees whilst simultaneous saving this scheme most meaningful amounts of revenue by preventing wasteful downstream costs, themselves as a result of involving the FPs in more Primary Preventative person centered Primary Healthcare, annual Physician Medicals, and post hospitalization patient visits.

I explained further that IPAF was also actively encouraging and measuring practitioners cooperation in their performance of twice yearly routine hypertension checks, annual determination of blood sugars and HBa1Cs in diabetic and other patients , annual Cholesterol screening, PSAs, Mammograms, Cervical smears, Flu vaccinations , HPV vaccinations.

I also highlighted our relationship with Discovery, Medscheme, Metropolitan Health Risk Management , Agility and CDE, for which IPAF, or in some cases its directors in their capacity as IPA leaders, performs a variety of services, including doctor education, distribution of contracts, advice to schemes on fairness of their contract offerings, introduction and support of Primary care programs by FP, intervention in contractual misunderstandings, representation of Family Practitioners views, Product design, difficult peer review matters and eradication of fraud to mention but a few.

The audience required little convincing that Primary Healthcare represented a fresh answer to the runaway tertiary and secondary costs of specialist     orientated hospital based care, whilst fully acknowledging the essential role that our Specialist colleagues play in their fields of expertise. 

Turning to the controversial Regulation 8 amendment which is out for comment, IPAF informed the audience that we did not see this as a threat to the PHC practitioners, as they were almost never involved in the charging of higher fees for PMBs, even when they had not signed DSP contracts with schemes. 

Two caveats however were:

Providing that Regulation 8 amendments did not permit reduction of CDL benefits, we would in fact support it once an initial realignment of the FPs consultation fees as a fair % of the specialist fees was considered and accepted by the schemes.

Finally, I was asked by Prof Chetty, the chairman of IPAF to address the Health Quality Alliance results ceremony in Johannesburg the week before the BHF, and offered the same message, together with a warning to the schemes that unless they rationalized their PHC offerings to their members, the methods of measuring doctor and patient compliance, that they were doomed to continue to see the pathetically poor national results which HQA reported upon in preventive care.

Schemes need to start to share important information, and offerings, and rather compete on service excellence and not on product design, because, in actual fact the funding industry has been the architect of their own upward cost spiral by chasing lives, and not primary healthcare

Currently the patients don't know what they are entitled to , and neither do the Primary Care Doctors.

Tony Behrman


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