Medical Law – Medical Practitioners and fees charged for services rendered: The HPCSA has set the deadline for Practitioners’ comments on its proposed Guideline Tariffs for 18 November 2013

The period for commentary on the HPCSA’s Guideline Tariffs lapses on 18 November 2013.  As these tariffs will be used by the HPCSA to adjudicate complaints pertaining to overcharging, we recommend that practitioners partake in this process.  The proposed process for commentary can be found on the HPCSA’s website.

The Health Professions Act 56 of 1974 stipulates that a medical practitioner registered as such under the Act shall, unless it is impossible for him to do so “…before rendering any professional services inform the person to whom the services are to be rendered or any person responsible for the maintenance of such person of the fee which he or she intends to charge for such services when so requested by the person concerned”. The Act further obliges practitioners to inform patients when a fee is going to exceed the usual fee charged for such services, and what the usual fee for such services would be.

In addition to this, the Consumer Protection Act 68 of 2008, which came into effect in 2011, stipulates that a supplier (or in this case a practitioner) may not offer to supply, supply or enter into an agreement to supply any goods or services at a price that is “unfair, unreasonable or unjust”. The Act further provides that practitioners have to inform their patients of the costs of services before said services are rendered. The latter provision is also a requirement of the National Health Act 61 of 2003.

It is clear from the above that there are strict provisions in place relating to the manner in which practitioners are to deal with the fees charged for specific services. However, none of the above-mentioned Acts set out legally determined tariffs which may be applied by practitioners in relation to specific services rendered. Attempts have been made to determine such tariffs but the Health Professions Council of South Africa (“the HPCSA”) scrapped its ethical tariffs during 2008 and the Department of Health’s reference price list was declared invalid by the North Gauteng High Court during July 2010. This lacuna as to pricing has caused much uncertainty in the medical community as a whole regarding what fees would be considered fair, reasonable and just.

In a press release dated 07 August 2012, the HPCSA attempted to clarify this uncertainty by announcing its publication of fees to be used as a norm in the determination of complaints relating to overcharging by healthcare practitioners. These fees, known as the Guideline Tariffs, were aimed at providing practitioners with clarity and criteria for determining fair and reasonable fees for the services that they render and were intended to serve as a guide to practitioners on what they can expect to charge for their professional services. 

In deciding these fees, the HPCSA used the 2006 National Health Reference Price List as a baseline and added an inflator of 46.66% until 2012. The HPCSA stipulated that practitioners could charge above the Guideline Tariffs provided that they obtained an informed consent from the patient or the patient’s next of kin.

The publication of these Guideline Tariffs was, however, met with strong opposition from the medical community as a whole as it was felt that the HPCSA disregarded the input of the relevant role players in the medical community in determining these fees.  The HPCSA has, accordingly, postponed the publication of these Guideline Tariffs in order that interested persons may make presentations to Council regarding what they considered appropriate fees for specific services rendered.

Practitioners should take note that interested persons may only comment on the proposed fees until close of business on Monday 18 November 2013. Having regard to the fact that these guideline fees, once published, will be used in determining complaints relating to overcharging we suggest that practitioners partake in the presentations made to Council. We further suggest that all practitioners familiarise themselves with the Guideline Tariffs once they are published on the HPCSA’s website.