In June 2017 the Council for Medical Schemes announced its intention to declare certain practices by medical schemes as irregular and undesirable business practices. The issues relate specifically to the appointment of Designated Services Providers (DSPs) in terms of Regulation 8 of the Medical Schemes Act, and penalty co-payments which schemes are requiring members to pay when they use non-DSP services.
SAMA would like to thank all the members who responded to our call for submissions in response to this important announcement - only doctors facing the terms and processes of medical schemes on a daily basis truly understand how these practices negatively affect patients and our overall goal of providing good quality healthcare in the private sector.
Our submission highlighted the many challenges and irregularities in doctor DSP and network contracts and network arrangements, the negative impacts of closed and limiting network arrangements and the questionable practices of schemes in effectively selecting practitioners and specialists for member care mainly on the basis of cost considerations.
SAMA_SUB_PMB Undesirable DSP_2017June302.pdf
Last updated Tuesday, 4 July 2017 11:19