What's really going on in this fight between the medical aids and the pharmacies?
I'M treading somewhat warily these days after the poison pen letter from an irate doctor who takes great exception to my suggestion that not all of his medical colleagues have their sights on the 21st century.
But medicine is hugely interesting. My father is currently in hospital undergoing treatment for Congestive Cardiac Failure. (Or CCF, as the doctors say.) So I scope out all the doctors.
Now I have a good rule of thumb for distinguishing a good doctor from a bad one.
Ask questions.
A good doctor will respond enthusiastically to your interest and provide you with as much information as you can handle.
My father is lucky.
A bad doctor will fob you off with things like "well, it's complicated" or "it's too technical to explain" or "well, the abnormal distension of the lower appendage has resulted in localised trauma".
"You mean he twisted his leg?"
"No, it's not that simple."
I had a similar routine in place when I trained student computer consultants at Princeton University.
"If a customer asks you a question," I would say, "and if you do not know the answer, give the answer to a totally different and unrelated question. This confuses the customer while making you look intelligent."
But let's leave the medical jokes aside. They're fine until they become doctors...
I've just received a letter from a pharmacy that I occasionally visit which I thought should receive a wider audience.
During the past two weeks, numerous press releases by Medical Aids have thrown a very poor light on the retail pharmaceutical industry. The main focus of these reports has been the adding of a ±R20 dispensing fee to prescription items, without disclosing the full facts of the matter. These are:
- Medicines are to be sold at COST PRICE, ie. NO PROFIT is to be made on the sale of medicine at all. This is in line with the wishes of the Department of Health, and has been discussed with the pharmaceutical and medical aid industry for the past three years. The use of generics will greatly reduce costs.
- The dispensing fee is is not R20 or R15 or any other set rand value but is based on a rate of R150 per hour. (Please bear in mind that medicines have to be dispensed by a qualified pharmacist who must have a five-year university degree.) Included in the fee is a 3% charge for the holding cost of the stock.
- What is really upsetting the Medical Aid industry is that the retail pharmaceutical industry wishes to cancel all existing contracts with medical aids and enter into new contracts with them. (NOT BOYCOTT)
- The main reason for this has nothing to do with pricing but centres around the fact that Medical Aids have the right to reject payments up to one year after a claim has been made for reasons over which pharmacies have no control (e.g. Member's fund exhausted, member resigned, etc.)
- At our chemist, we experience up to R60000 per month of rejections. The administrative cost of trying to recover this money is astronomical, and a large percentage is never recovered. Any intelligent person will understand that no commerce can exist where goods (medicines) are supplied to a customer in good faith, and a third party (Medical Aids) have the right to refuse payment months later.
Interesting. Vic, the pharmacist, also points out that many medicines, like Prozac 28's (R245) and Prepulsid 90's (R598) become significantly cheaper (R181 and R412 respectively) to the consumer under the new scheme.
Would any lawyers care to join this discussion?
I have lots of lawyer jokes.