The KwaZulu-Natal Doctors Healthcare Coalition (KZNDHC) has written to the chief medical officer of the SA Municipal Workers Union Medical Scheme (Samwumed) expressing its dissatisfaction that while member fees went up by 10%, and all other providers, including specialists, pathology, radiology and hospital groups, received an increase, only GPs were exempt.
As a result, said the KZNDHC: “The doctors have resolved that we will see Samwumed members but will ask them to pay us cash. We will give them a receipt, and then they can claim from the medical aid. Most of the doctors who have agreed to this are from KZNDHC, which is about 1 500 doctors. Members must take the fight to the board of directors of the medical aid.”
In his letter to the members, KZNDHC CEO Dr Neven Govender wrote: “Samwumed wanted us to explore options to help reduce their costs further. This despite GPs being the lowest-cost drivers, and specialists and hospital groups being the higher costs drivers. Their ‘reason’ (excuse) behind their 0% increase was that they had felt GPs were paid a far higher rate historically by the scheme.”
He said he had pointed out that schemes like LA Health, which also serves municipal workers, had tariff fees in line with inflation, with a consult fee of R544 (versus R475 as Samwumed network provider, or R429 as non-network provider.”
They had also alerted the scheme that their costs had increased disproportionately to their tariff rates and that they had been on the receiving end of looting and floods, to no avail, reports TimesLIVE.
The scheme maintains that GPs do not deserve an increase from the 2022 tariff, which remains at R475 (or R429), while it continues to reward its specialists and hospital groups which have driven costs.
As a “network doctor” to Samwumed, Govender said, you will be peer-reviewed, restricted to billing the network rates, “audited” for being expensive, and expected to manage the costs of the scheme by changing your referral patterns, hospitalisation usage and so on.
“Doctors deciding to exit their network agreement are not bound by this and can charge co-payments to their Samwumed patients in keeping ‘expensive’, referring to specialists or admitting a patient to the hospital,” he added.
One of the doctors who spoke to TimesLIVE and asked not to be named, said he was shocked by the refusal.
The doctor said what was also puzzling was that they increased fees for others, but not GPs.
“The 0% increase is a shame considering that the cost of living has gone up, and the cost to run a practice is up. All 209 medical aids in the country gave us an increase except for them,” said a doctor.
The scheme said it was aware of the matter and would be tabling KZNDHC’s request to revisit the decision at the next board meeting later this month.
“The recommendation, tabled on the 2023 GP rate by a scheme partner, was discussed extensively at the benefit committee,” said the scheme’s clinical executive, Dr Andrew Good, adding that the scheme was reassured that even if it did not increase the GP rate, the scheme GP rates would remain competitive in relation to other schemes in the industry.
“GP benefit funding from risk benefits at Samwumed is more than 9.5%. This compares favourably with the GP funding from risk benefits of 5.71 % for restricted schemes and 3.11% for open schemes, as reported in the last Council for Medical Schemes (CMS) report,” he said.
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