A critical analysis of private practice billing guidelines for health professionals in South Africa

Abstract

South Africa`s private healthcare sector and the fees charged by private health professionals has become a major challenge and concern. The rising costs in the private healthcare sector are unsustainable and urgently need to be addressed. There have been several failed attempts by various role-players to establish a credible pricing benchmark. There are a number of shortcomings and obstacles faced with the current guidelines provided to the private healthcare sector. The current Health Professions Council`s guidelines fail to define and advise what constitutes as overcharging with no booklets addressing this legal and ethical issue. I consider the legal and ethical implications where a health professional overcharges for their services. Rampant commercialisation in healthcare will destroy the traditional respect for the healthcare profession which has been carefully earned and deserved over the centuries. This forms the basis of my argument, that the current guidelines which govern billing practices of South African health professionals are ethically and legally inadequate. I claim that there is a compelling need for the regulating bodies to set and implement an “ethical billing range” for South Africa`s private healthcare sector. This “ethical billing range” would support and assist to better protect health professionals, medical schemes, and patients alike. The “ethical billing range” will also assist to curb the rate of private healthcare spending and promote sustainability in the private healthcare sector. This will further lead to improved access to healthcare services. I conclude that complete and comprehensive billing guidelines will address the ethical and legal inadequacies that exist in the current billing guidelines. This will not only benefit private healthcare, but healthcare in its entirety within South Africa.