Covid-19: No agreement between private health sector and govt over treatment tariffs

• The government has offered private healthcare providers a flat rate for treating Covid-19 patients, but the private sector has not accepted the offer.
• The flat rate offered is regardless of whether the patients are in ICU or not, but private practitioners want double the rate for ICU patients.
• All other costs, such as medicine required to treat the patient, are included in the fee.

With epidemiologists expecting that thousands of Covid-19 patients will need hospitalisation within the next two months, as the pandemic nears its peak, private healthcare practitioners and the government are still haggling over national Department of Health (NDOH) tariffs for private doctors who will treat state patients for Covid-19.

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With two thirds of the country's ICU beds being in the private sector and state facilities suffering from capacity constraints, the government will need the services of the private healthcare sector if it is to cope with the surge of patients expected in the coming months.

Negotiations between the sectors has been ongoing for months with a mutual understanding that they will need to work together to prevent the healthcare system from being overwhelmed once the epidemic reaches its peak, in about late August.

Documents seen by News24 show that the department has offered private doctors and specialists a R2 493 per diem rate for their services, excluding extra costs like intubation, if they treat "state responsibility" patients in private facilities.

The department is also willing to pay private hospitals R6 286 per day, R632 for radiology, and R588 for pathology services.

The fee will have to be split between specialists if more than one specialist is required to treat a patient.

Internal communication by private healthcare providers belonging to the SA Private Practitioners Forum (SAPPF) was leaked this week, and, according to Daily Maverick, it shows that the parties have tried to reach an agreement without success.

The private practitioners have reportedly asked for different rates for ICU, high care and general ward patients, with the ICU tariffs at least double the department's flat rate offer.

The rationale seems to be that different specialisations are required to treat patients in the different wards, and more than one doctor will be needed when patients are critically ill.

The department's offer of a flat rate of R2 493 is standard, whether the patient is in ICU or not.

In terms of draft service level agreements seen by News24, all other costs, such as medicine required to treat the patient, are included in the fee.

Department of Health spokesperson Popo Maja told News24 that the department could not comment on "employment contracts" in public.

"It is confidential information agreements between parties," he said.

The contracts are due to be standardised across all provinces, in the likely event that the government will have to send Covid-19 patients to private facilities when public hospitals reach capacity.

National Health Insurance

Privately, doctors are concerned that the agreements will be used when the National Health Insurance (NHI) becomes a reality and that the terms will remain permanent.

But Nicolas Crisp, the public health specialist heading up government's NHI office, said the two were unrelated.

Crisp said the department wanted to create a standard tariff that could be used across all provinces but that the issue was being talked about in the Western Cape because it was further along in the epidemic than the other provinces.

"It has got nothing to do with the NHI. It doesn't even resemble what's in the NHI Bill," he said.

He described rumours that the tariffs were related to the NHI as a "red herring".

Terms of agreement

The draft service level agreements indicate that the agreements will remain in place "for the duration of the national lockdown period under the Disaster Management [Act] or until 30 August 2020". Thereafter, the agreements can be renegotiated for 90 days.

Under the agreements, private providers must appoint an independent administrator to deal with "all administration processes" with the department. The administrator will also be responsible for dealing with medical aid schemes if the patient belongs to one.

The referral of state patients to private practitioners will be up to the department only and doctors will not be able to compel the department to transfer any patients.

The department will appoint a project manager that will act as its main point of contact for every contract. All patients will have to be registered on the department's system, and "such patients will always remain defined as patients of the department".

The department will also be responsible for confirming that the department and the provincial and national treasuries have enough money to pay the private providers, and have to share patient information with the private providers.

The agreements envisage the establishment of various joint operations committees which will handle billing and other disputes, as well as operational matters for the private healthcare providers.

Under negotiation

In a statement, the SAPPF said it was aware that internal communications had been leaked to the media and added that "despite whatever difficulties have been encountered in engaging government", it was committed to achieving a workable solution.

"The environment is complex and with many parties involved, and [the] SAPPF is encouraged by the recent progress achieved. … it is clear that there is no response to the pandemic without healthcare providers and we are acutely aware of the dangers these individuals face in performing their duties. We have a responsibility to our healthcare providers and will continue to work in a collaborative manner to craft a workable solution."

News24 asked private hospital groups for comment on the fees and whether the contracts had been signed.

Mediclinic South Africa chief clinical officer, Dr Stefan Smuts, said: "Mediclinic is currently engaged in ongoing discussions with the national Department of Health in this regard. The private hospital industry, as a collective, is not allowed to discuss any tariff issues in the public domain as this would contravene the Competition Act."

Melanie Da Costa, director strategy and health policy at Netcare, said: "To our knowledge, no decisions have been made. We can confirm the discussions remain ongoing and that the NDOH is still to finalise its position. All parties are committed to finding common ground that is workable to care for Covid-19 patients."

Matthew Prior, funder relations and health policy executive for Life Healthcare said: "A process to establish pricing for the treatment of state patients is currently under way and we are engaging with both national and provincial government departments regarding the collaboration of shared resources as a result of the Covid-19 pandemic.