There are as many views on whether doctors charge too much for their services as there are patients that visit doctors. Medical aids in South Africa set their rates for services by doctors and pay that as a benefit to contribute towards the cost of healthcare, no matter what the doctor charges. Each medical aid sets its own rate. The rates set are remarkably similar across various medical aids as they have all been increased for inflation annually off a base rate that was set across the industry some years ago.
There is a tacit acknowledgment from many medical aids that their rate is too low in that, when they contract with doctors to be part of their networks, they often contract at a rate which is 1.5 or 2 times the medical aid’s rate. Many doctors feel that even 2 times the medical aid rate is too low and charge at a rate which is 3 to 4 times the rate. I don’t want to debate what is an appropriate rate, or discuss what are acceptable levels of earnings for doctors. Doctors in private practice, like any other business person, should set their fees at a level which they believe is appropriate and fair, and let market forces prevail – to the extent that market forces work in the healthcare market.
What puzzles me is why some doctors set a fee for their services to most patients, but increase that fee when they learn that their patient has additional insurance (like gap cover) over and above their medical aid. The patient’s insurance policies should have no impact on the fee charged. The fee should be determined by the cost base, the level of expertise, the services rendered, the risk carried by the doctor, and other similar factors. Surely bumping up fees in this way smacks of simply gouging as much as can be grabbed out of the system? This pricing behaviour has no justifiable basis.
What do you think?
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