Managed care has created some confusion and misunderstanding. Legal processes are used to cloud ethics. The doctor’s leadership is undermined by the use of “service provider”, thereby weakening the doctor’s role in disease management and the “feels right” ability to assess 3rd party interference. Managed care attempts to place “case managers” in control of disease management. Interference in the doctor-patient relationship is inevitable. Managed care sets tariff at differential rates according to plans (unjust!), selects doctors and medicines (autonomy!), and places cost before quality to ensure 3rd party profits and returns for shareholders. Unethical, yet it is a successful R2billion business in South Africa, all from patients’ premiums with little or no opposition from doctors. It surely contravenes the Consumer Protection Act and is currently under investigation. Hopefully the law will succeed where doctors have regrettably failed to protect their patients from this abuse. Conclusion The Ethical Tariff is not what you charge, but how you charge. It is a fair and just fee applied with regard to your patient’s right to autonomy, freedom of choice and quality medical care. It is a tariff that honours the doctor patient relationship without 3rd party interference. It takes cognisance of our fiduciary responsibility to cost effective care without sacrificing quality. The quantum is based on cost, experience and outcomes, respecting your patient’s right to time, respect and compassion. References: CMS report May 2010, B Steenekamp. Financial overview of the DHMS 2010 Annual Report. S Eiser, June 10, 2011. The High Court of South Africa case no. 37377/09, 28 July 2010, The Honourable Mr Acting Justice Ebersohn. CMS report 2010. HPCSA Policy Document on Undesirable Business Practices. Medical Ethics, Section 1. The Foundation for Professional Development, 2002.
Managed care has created some confusion and misunderstanding. Legal processes are used to cloud ethics. The doctor’s leadership is undermined by the use of “service provider”, thereby weakening the doctor’s role in disease management and the “feels right” ability to assess 3rd party interference. Managed care attempts to place “case managers” in control of disease management. Interference in the doctor-patient relationship is inevitable. Managed care sets tariff at differential rates according to plans (unjust!), selects doctors and medicines (autonomy!), and places cost before quality to ensure 3rd party profits and returns for shareholders. Unethical, yet it is a successful R2billion business in South Africa, all from patients’ premiums with little or no opposition from doctors. It surely contravenes the Consumer Protection Act and is currently under investigation. Hopefully the law will succeed where doctors have regrettably failed to protect their patients from this abuse. Conclusion The Ethical Tariff is not what you charge, but how you charge. It is a fair and just fee applied with regard to your patient’s right to autonomy, freedom of choice and quality medical care. It is a tariff that honours the doctor patient relationship without 3rd party interference. It takes cognisance of our fiduciary responsibility to cost effective care without sacrificing quality. The quantum is based on cost, experience and outcomes, respecting your patient’s right to time, respect and compassion. References: CMS report May 2010, B Steenekamp. Financial overview of the DHMS 2010 Annual Report. S Eiser, June 10, 2011. The High Court of South Africa case no. 37377/09, 28 July 2010, The Honourable Mr Acting Justice Ebersohn. CMS report 2010. HPCSA Policy Document on Undesirable Business Practices. Medical Ethics, Section 1. The Foundation for Professional Development, 2002.
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