The Mail & Guardian asked readers what they think of doctors' tariffs in a survey on M&G Online.
Most respondents (71%) believe that medical tariffs should be regulated, but there is no consensus on how this should be done.
‘Yes [they should be regulated]. Medical professionals are not the beacon of morality we assume them to be.
Like everyone else, they too have become too greedy, and consider themselves above the law. The public must be protected. I understand the time and effort it takes to qualify as a medical professional, but being a doctor is a vocation. If you are in it for the money then clearly the medical school made a huge blunder by admitting you. Health cannot be placed alongside other commodities with free market principles. If it is, it means that those that need the service the most will have the least access."
– Benjamin Landuleni (37), chartered accountant – Johannesburg
"I definitely think doctors and dentists, in fact all doctors especially specialists’ fees are absolutely too high. We retired two years ago and have had to downscale our medical aid. We are healthy at this stage but do not know how long this will last. However we dread any medical attention we just cannot afford. Doctors are not practising for the love of the profession, only because it is so well paid. They could not care two hoots about anybody. It is just a money making profession. So sad!"
– Anonymous Female (64), retired, Pretoria
"Yes [they should be regulated], because [doctors] do seem to overcharge, especially people that are going to claim from medical aid. A regulation should give a range that they can charge, taking into account facilities and location."
– Jane (32), analyst
"Yes [they should be regulated], some doctors charge an arm and a leg for services rendered. I have experienced it here in Midrand."
– Malose Buthane (34), IT facilitator, Midrand
"Yes [they should be regulated], healthcare is becoming unaffordable to many people, doctors and especially the specialists’ fees have become astronomical – way beyond what I as pensioner can afford."
– Ken (73), retired
"YES [they should be regulated]!!! I pay almost R1000 per month for my medical aid and it only covers 85% of my out of hospital consultation. The higher the charges for consultation, the higher the 15% balance is going to be."
– Lebo Ramoshaba (30), sales executive, Johannesburg
Some readers disagree:
"Imposing price regulation on a health market characterised by under supply of doctors and nurses to meet public demand can never work – it is unconstitutional and professionals will simply go elsewhere in Africa and the world to earn a living. However, the buying power of primary care and prescribed minimum benefits (PMB) networks such as CareCross, KeyCare and Prime Cure show that prices can be controlled and better resourcing provided to the public, if the State were to consolidate and leverage combined buying power together with medical schemes, by voluntarily contracting in health providers. Specialists, in particular anaesthetists, face such extreme over demand compared to supply, that price control in any form cannot work."
– Mike Stow (41), medical aid broker, Port Eizabeth
"Regulating prices will drag down the quality of service provided by doctors. Why should they go the extra mile? South Africa is a democracy where people have the freedom to choose; freedom from being forced to see a certain doctor, and the right to choose if they want the treatment or not. Free market system dictates better products or services cost more. If there was better administrative accountability (form local and national government level), the current health care setup would work just fine."
– Christiaan Barnard (31), doctor, Cape Town
Of the 48 respondents, 56% said doctors and dentists in South Africa don't charge reasonable rates:
"The local general practitioner charges more for a 20-minute conversation about a cold than I pay for a tank of petrol in a month!"
– Anonymous female (31), administrator, Johannesburg
"My family practitioner charges me R350 for a consultation without treatment when I use my medical aid – yet when I pay cash he charges me R200."
– Tau Tsibela (28), health administrator, Bloemfontein
"Doctors collude to fix prices and there are too few competent specialists in private practice now."
– James Milton (35), lawyer
"Some yes. Most No. Specialists in particular are out of control with their prices and this needs to be brought down with medical aid tariffs. For example - yesterday I needed to make an appointment to see a dermatologist regarding a possible cancerous skin growth and they wanted R580 in cash upfront (which would then be submitted to medical aid). That is a week’s groceries. I have no other choice of specialist out here and this doctor comes in from Cape Town once a week. Petrol is too horrendously expensive to drive down to CT. It is grossly unfair as rural workers are not only paid less than in cities but pay more for food."
– Anonymous Female (54), house executive, Saldanha Bay
29% feel the current rates are reasonable:
"It’s difficult to say. It comes down to training. Why should I, as a specialist with 10 years of under and postgrad training and 6 years of experience as a specialist get paid R800/hour? This is unsustainable. I agree that charging R5000 to provide spinal anaesthesia for a half hour caesarean section is unreasonable."
– Anonymous Male (38), medical specialist, Johannesburg
"They are charging according to their worth. I am a sub specialist, and most of my practice is out patient based. There are only 50 of us in this particular sub-speciality in the whole country and I charge R1000 for the first consult which takes an hour. The subsequent visits attract a charge of R600 for 45 minutes. Despite this, I am fully booked for several months. The medical aids want to pay me R400 for a consultation. Due to unhappiness by more than a few of my South African patients about my fees, and medical aid restrictions, and unpaid debts by patients, I am now targeting rich Mozambicans and Angolans who fly down to see me (and also check on their properties here). To this end I am learning Portuguese. I am considering doing away with South African patients altogether. These medical tourists are more humble and they never complain about my fees. In fact they think my fees are ridiculously low. But I do think a few medical specialists are charging extortionate fees. For example, a visit to a cardiologist will leave you R6000 poorer an hour later. Some of my non-medical friends have been cheated, for example a friend was charged R4000 for a consultation with a Nephrologist, with nothing special done except for a urine dipstix. That visit took only 30 minutes. There is no justification for these stratospheric fees, but it is due to absence of competition. Many specialists have emigrated due the failure of the ANC government to control crime."
– Anonymous Male (40), medical specialist, Johannesburg
Others are unsure:
"Some do, some don’t. I have just changed from a very expensive dentist to a cheaper one with just as good service."
– Anonymous Female, artist, Durban
Some patients said they have been exploited by doctors:
"A doctor charged us about R750 for the overnight rental of a finger pulse monitor and another small piece of medical equipment without informing us beforehand of the costs involved."
– Anonymous female (54), housewife, Saldanha Bay, Western Cape
"R15000 to have an orthopaedic surgeon set a fractured collar bone seemed over the top."
– Howard Bird (55), financial adviser, Johannesburg
"My family practitioner charges me R350 for consultation without treatment when I use my medical aid yet he charges me R200 when I consult cash."
– Tau Tsibela (28), health administrator, Bloemfontein
"A cardio-thoracic surgeon charged me about R4000 for spending 10 minutes at my bedside when I had a lung collapse. He was not there when the surgeon cut my chest to let the air out my lungs and that surgeon only charged R800. The cardio thoracic surgeon was simply inspecting the work of the surgeon; the medical aid happily paid him.
– Mark Nel (46), former division manager of finance, Johannesburg
"Yes. I have been overcharged by a pulmonologist (lung specialist), a gastroenterologist, a urologist and an orthopaedic specialist many times over."
– Ken (73), retired
Even industry insiders said their colleagues are exploiting patients:
"A gynaecologist once charged me a ridiculous amount of money for a consultation. When I queried the charges I was told it was because female gynaes are very scarce and I had to pay for the ‘privilege' of being treated by one. "
– Renee Higgs (32), doctor, Bloemfontein
"I am a specialist and I get a bad name from other specialists who charge double what I do. Also, charging medical aid rates places me at the mercy of some dodgy funds that pay hardly anything, and fleece their members for fees, compromising both the patient and the doctor."
– Anonymous female (36), anaesthetist, Johannesburg
Readers were asked whether they thought the Department and the Minister of Health have a hidden agenda:
"No, doctors are over sensitive and overprotective. They are fleecing us."
– Anonymous Male (31), engineer
"The HPCSA has become redundant and managed by incompetent lazy people from top down. This has worsened over the years ever since the previous Minister of Health changed the legislation to favour more government interference and control and diluted the input from medical practitioners. The anecdotal stories including my own personal experience of dealing with it would fill a book. The Health Minister unfortunately misunderstands the separation between private and public healthcare; he believes that by driving down costs in private it will lead to savings overall which can be diverted into the NHI. This of course won’t happen as the scourge of corruption and mismanagement of public money needs to be righted."
– Anonymous Female (51), doctor, Durban
"No, the HPCSA and Motsoaledi want to get SA back on track and in line with international acceptable levels. Don’t forget a doctor is a public servant and should be paid accordingly."
– Marlon (44), engineer
"Definitely! The HPCSA and the health minister realise that they will have to pay private doctors and dentists to see some patients under the NHI plan, and they want to keep the prices as low as possible. Unfortunately this creates a market and ethical standard and expectation of what services should cost, and those doctors who charge more are seen as overcharging and money-grabbing."
– Anonymous Male (31) doctor, Cape Town
"No way. Many years ago there was a so-called medical aid rate and a doctor had the option of contracting out, yet the patient had a choice whether to pay the thus increased charge or not. Abolishing this system was a big mistake."
– Anonymous Male (78), retired university professor, Johannesburg
"I don’t think so. They are genuinely trying to keep the cost of medical care reasonable and affordable as much as possible for average South Africans."
– Joe Jacob (44), educator, Queenstown