Wednesday, December 8, 2021

Medical aid bodies attacked for anti-competition practices

The Botswana Dental Association (BODEA) has filed a complaint against local medical aid service providers Botsogo Health Plan, Pula Medical Aid, Botswana Medical Aid (BOMAID) and Botswana Public Officer’s Medical Aid Fund (BPOMAS) with the newly established Botswana Competition Authority, citing “Competition in relation to the practice of dentistry in Botswana.”

BODEA argues that the tariffs agreed upon stifle competition among dentists in Botswana and they state in a letter to the Competition Authority that, “There is an insignificant variation in the dental tariffs among the four medical aid schemes.”

The members of BODEA feel that this “collusive” act limits competition between private practitioners in dental care.

Duncan Thela, the Chief Operations officer of the Associated Fund Administrator (AFA), administrators of BPOMAS and Pula Medical Aid, explained that they undergo an annual review during which dental tariffs are decided upon.

Before a decision is made, they look at the qualifications of specialists, the time spent on a particular operation, the consumables used and the prescribed medication to establish the baseline tariffs. The AFA then further takes into consideration the regional (South Africa, Zimbabwe, Botswana and Namibia) standards looking at financial performance, what is available in coffers, they also make projections basing on past premiums, claims and determine a way forward sometimes with recommendations from their actuaries.

For their part, Botsogo Health Plan indicated that their priority was to create the best possible conditions for their clients who also happen to be the patients of the members of BODEA.
Marketing Manager, Ernest Molome, informed the Sunday Standard that by virtue of having these tariffs they are also protecting themselves from fraudulent practices that may occur in a situation where there is a “Free Market.”

Molome further stated that practitioners do not have set prices for their procedures and charge according to patient and by so doing they are contradicting the “Fair Practice” which they claim to be advocating for.

The Competition Act of Botswana 2009 states that “An enterprise shall not enter into agreement with another to the extent that such agreement involves directly or indirectly fixing a purchase or selling price or any other trading condition.”

Thela of the AFA explains that the “insignificant variations in dental tariffs” are purely coincidental since they stopped negotiating tariffs with other medical aid service providers in the early 2000s.

For fear of victimisation, a member of BODEA stated anonymously that, “The tariffs are generally not agreed upon. The medical aids prescribe to the doctors what they should charge. The doctors as the sellers of the services should be the ones determining prices for procedures. The set tariffs are anti competitive. There’s no price competition between doctors. This has led to a stagnated dental industry. Competition in any industry always leads to increase in quality of service.”

BODEA and Botsogo Health Plan had agreed on an increment of 4.5 percent effective January 1st, 2011. BODEA, however, discussed this further and agreed on increasing “some of their service codes between 50-200 percent”. This was agreed to increase competion which will ultimately improve service delivery.

In an effort to inform their members, Botsogo Health plan issued a memorandum which stated that patients should discuss treatment plans and fees prior to any action and that they should be aware that any costs incurred higher than what the medical aid is prepared to pay will be settled by the patient.

This matter is still with the Botswana Competition Authority and will be dealt with accordingly.

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