cerebus
Honorary Master
Jonathan Broomberg would like to personally thank you. If only more South Africans had your attitude!
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Question of the Day: If you were buying a TV today, which brand would you choose?
Why Discovery is so expensive
- Thread starter Kevin Lancaster
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Jonathan Broomberg would like to personally thank you. If only more South Africans had your attitude!
No, it isn't.
supersunbird
Honorary Master
Then put is up...
You're obviously better informed than I am. Please feel free to put up said lists. I wonder if you can even name all the medical aids in South Africa?
NarrowBandFtw
Honorary Master
Huh? You said it was impossible. I'm refuting that statement because it is categorically /not/ impossible.
I did not say I have the information to do so.
Nerfherder
Honorary Master
Its a combination of all three of those things.
1: People try and defraud Medical aid all the time, the doctors collude.
2: Private hospitals are private enterprises and are profit driven.
3: Medical aid is also private and also needs to make a profit.
Hence none of these services work as intended. As they are all profit driven, they all end up costing the consumer.
OK, I understand that it's not technically impossible. But let's assume most surgical disciplines have only a 100 different procedural combinations for 25 odd more common specialities. That's 2500 tariffs. Now let's say 30 medical aids. 75000. And what about medical aids with 4 different payment plans, depending on their agreement with the doctor? Now sitting at 300 000 tariffs!! And most of that is in code format - so a consult is written 0171, not consult, so even if could publish it, how much would it help you?
Would really be willing to sift through that?
Arthur
Honorary Master
I prefer to choose for myself where I sit on price vs quality. Would hate the government to regulate this, because with government quality always suffers and the real price is impossible to determine because its hidden.
Your point 1 is far too sweeping, and, for doctors, probably wrong 95% of the time.
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I would. I'm an obsessive data miner.
I don't understand why private health care should not be allowed to be profit driven?
As for collusion - please specify examples if you would like to generalise like that. Closest to requests for collusion I get, come from patients, not colleagues. Conversation normally goes like this - Mrs Smith, you need to have the following tests done. Oh, doctor, we can't afford it and my medical savings are exhausted. Can you not admit fee for pain or something? Then my medical aid will pay for it.
The new data should apparently be available by 1 April 2016. Feel free to drop me a pm around then and I'll see if I can send it to you. If I remember correctly, they only give the '100% tariff', so if a specific doctor has a payment agreement for 146% for instance, you'll have to work it out.
Nerfherder
Honorary Master
No, well firstly not all doctors are colluding. Not all private doctors either. The point is that there are doctors that will inflate or make false claims. When the service is money driven its going to happen. They have no incentive to not do this.
I also choose a private, mainly because I don't want to wait 6 months in a queue. The best doctors in the country service both private and public patients - our healthcare system is that burdened.
I can tell you now that with private quality also suffers. All you get is shorter queues and clean wards. Profit also compromises quality, the advantage of not having profit as a driver is that you have other focus like preventative medicine.
Spend time in any private hospital, its easy to see how they add expensive tests and services to 'cover costs'. You will get charged when a doc walks past your bed.
For a consultant doctor to cover the emergency room at Milpark for one weekend they take home almost 60k, you don't even need to come in to the hospital to get paid.
There is no incentive to actually heal people or even help them.
Even if the cost is hidden with government hospitals, their goal is to help as many people as possible - while reducing the amount of people that come in. Our gvt hospitals might suck but they at least have they right idea, just massively overburdened.
Nerfherder
Honorary Master
Im not saying that it should not allowed to be profit driven... its just then that we must not expect it to be different to how it is.
I'd respectfully like to disagree with that. I've worked extensively in the public sector, and shorter in the private sector. You get good and bad doctors in both. In private practice, you work on word-of-mouth referrals. So, if my patients are happy, they send more patients to me = more money! In government sector, however, there are many doctors that just go - well, I get a fixed salary, regardless of how many patients I see or the level of care I give. That type of attitude CAN'T fly in private practice, because your practice will die.
I'm not saying they're all like that, but I worked with a lot of doctors with that attitude.
Nerfherder
Honorary Master
Sure, they are all humans. The bigger problem is the lack of doctors. Because there are so few we are forced to keep the bad ones we have.
Anyway.. Bad Doctors are one part of the problem.
RogueTr00per
Honorary Master
I am going for a non surgical procedure in less than 48 hours. I have been trying since last week to find out what I am going to have to pay. The Intercare says they can't tell me what it's going to cost I must phone Discovery. I do so, then Discovery tells me I need the procedure code and practice number from Intercare first. After a couple more calls I get that info and call Discovery back, they tell me their rate for that code but they can't guarantee that the Intercare will charge that rate. Like WTF?! :wtf:
No wonder my old man throws a fit when I ask him to find out beforehand what his various procedures are going to cost before he goes in.
Mmm, that sounds like bad management by Intercare. The more I read, the more this seems to be the norm, unfortunately.
Kosmik
Honorary Master
A published mean tarrif would be great. Then folks can judge whether a provider is ripping the ring out of the them or not. At the moment who does a person know what one practitioner charges to another?
bumbledore
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None of them do. Not a single one.
That figure, to the best of my knowledge, came out during the SCA ruling against Genesis Medical Scheme in 2015.
Will try and find definitive source.
EDIT:
Also, no such thing as a "comprehensive" hospital plan - Schemes are obligated, by law, to cover 270 PMB conditions - all in-hospital, some out-of-hospital (but not all; try convincing any medical scheme to have your 21 days inpatient substance-use treatment converted into outpatient benefits - despite costing them less, they'd tell you to take a long walk off a short cliff). Some conditions, despite being incredibly common, will not be covered *at all* (anxiety disorders, for example).
Schemes are able to place sub-limits and other restrictions on members by entering into DSP (designated service provider) agreements with practitioners and hospitals. While some plans may have higher sub-limits and thresholds, they are all intrinsically the same in terms of the specific health conditions they will cover.
If it's not a PMB, then best of luck trying to get the scheme to pay for it. Even if it's cancer.
https://www.aon.co.za/Assets/docs/h...al-scheme-scripts/Cancer_when_is_it_a_PMB.pdf
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