Michelle Beneke

What has
become apparent during the ongoing Section 59 investigations prompted by
allegations of racial profiling of healthcare services providers (HSPs) by
medical schemes, has been the general complexity of the environment and “a lack
of understanding of how the funding industry works”.

This, in
fact, should be among the key learnings that should be drawn from this investigation
process, Michelle Beneke, of Volvere, legal consultants to the Board of
Healthcare Funders (BHF), said yesterday at the BHF Healthcare Forensic Management
Unit Indaba in Rosebank, Johannesburg.

And root
cause of the whole debate, she pointed out, had to be tariffs – in particular the
impact of the uncertainties brought about by the Competition Commission’s 2004
intervention in the funder/provider negotiating process. This, she said,
resulted in unchecked costs escalation, disharmony, and made the GPs, already the
weakest on the payments list, “even weaker”.

Tariff
codes being at the heart of the debate, the Health Market Inquiry (HMI) report,
Beneke continued, now provided opportunities to acknowledge the problems and pursue,
for example, the pro-competitive advantage for tariff negotiation. Being
industry-driven, this should provide clarity on erstwhile stumbling blocks such
as contractual consensus and ultimately a possible reduction in costs.

“Importantly,
it simplifies a complex environment,” she stressed, posing questions such as:
could developments such as the racial profiling allegations be a “way of
articulating frustration with a complex system”, and provide an “opportunity
for industry introspection”?

“Has it
not also created a platform for engaging and rebuilding relationships that
underpin a healthcare ecosystem?”

In terms
of the lack of understanding among providers of how the healthcare funding
industry works, Beneke stressed once again in her concluding remarks the vital
need to simplify the complex environment that exists between and among
providers and funders.

An
important consideration in this regard, she contended, would be for medical
schools to introduce a module to prepare the future practitioners for the
environment into which many of them would be entering.