Medical scheme benefits for 2007.

SAMA has made a spreadsheet available regarding the benefits that 85% of medical schemes are likely to pay to doctors for their services in 2007. This information has been compiled by the Society for General and Family Practitioners (SGFP) (an affiliated group of SAMA), and the National Convention on Dispensing (NCD), of which SAMA is a member.

Since a ruling by the Competition Commissioner in 2003 against anticompetitive behaviour in the health care funding industry, schemes have had to determine their own tariffs for doctors' services and patient benefits.

While there are still no regulations in place to facilitate the publication of the National Health Reference Price List (NHRPL) for 2007, this process is underway. In the interim, the spreadsheet gives an indication of schemes' tariffs as well as schemes that accept balanced-billing and those that pay out more than the CMS recommended inflator of 4.9% on the 2006 NHRPL. These schemes are colour coded in blue and yellow, respectively.

Meanwhile SAMA is also studying the increments made by the funding industry, as well as recommendations made by managed care and other organisations on adjustments to tariffs by service providers for 2007, and will report on the outcome in due course.