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  1. #41
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    Default Re: There are good well priced doctors and not greedy

    To take the analogy of surgeons vs say mechanics a bit further. As a mechanic (or any other trade) you can increase your income by hiring extra help and pay them x and charge x+y for that. That is basically how most people go foward. Although it does happen in the medical world, it is not as straight forward. So over time (for lack of a better term) is almost mandatory.
    There is never a right time to do the wrong thing and never a wrong time to do the right thing!

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  3. #42
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    Default Re: There are good well priced doctors and not greedy

    Quote Originally Posted by Half-Pint View Post
    I'm not as smart as Estee but I would assume the other issue is that unlike a manufacturing environment the production tool is an organic being. Therefore with an increase in working hours his performance will surely decline.

    If my surgeon is working 18 hr days to make ends meet I would be worried. I would rather go to the surgeon who charges me sufficiently that he can make a living off a normal working day. Hopefully he will arrive to chop me up having had a good night's kip and not doze off with me splayed open on the table
    Manufacturing environments also, hence the limits set to OT hours. Unlike manufacturing though, the medical proffession has a number of constraints and unique dynamics that prevent them from being able to respond to demand like a manufacturer could.
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  5. #43
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    Default Re: There are good well priced doctors and not greedy

    Quote Originally Posted by Francois Theron View Post
    To take the analogy of surgeons vs say mechanics a bit further. As a mechanic (or any other trade) you can increase your income by hiring extra help and pay them x and charge x+y for that. That is basically how most people go foward. Although it does happen in the medical world, it is not as straight forward. So over time (for lack of a better term) is almost mandatory.
    The only extra help that a surgeon can hire is another surgeon so we are back to square one. The business model that makes sense is to rather reward the surgeon based on outcomes which means a basic fee for the procedure and an agterskot from the MA if there are no re-admissions in say a year. The savings to MA and ultimately it's members are huge, in my example revision surgery for a R160k procedure starts at about R250k and I have seen bills of over R3 million in severe cases. Add to this the trauma endured by the patient it would make sense to rather pay to get it right first time, which goes against what is being proposed in this thread.

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  7. #44
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    Default Re: There are good well priced doctors and not greedy

    Going private means that you have to and will pay a wad of cash if you don't have a decent medical Aid. ( The 1st question the receptionist will ask acting as if she is the Surgeon herself)

    It is a reality though that many people cannot afford these crazy prices and we are succumb to bargaining for price.
    unless you are happy to sit in line at your local government hospital and wait up to a year for a slot re your injury.
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  8. #45
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    Default Re: There are good well priced doctors and not greedy

    Quote Originally Posted by Stan Weakley View Post
    Milady, perhaps you might also be wrong to some extent.

    A "mechanic, plumber, attorney and Indian chief" can charge any fee for their services that they deem fit. The maximum fees of a doctor are controlled by legislation and doctors can be permanently barred from medical practice by the statuary medical control council for overcharging.

    The vast majority of doctors in South Africa charge well below the maximum allowed rate.

    The misapprehension begin with the misunderstanding that medical aids can determine the fees of a doctor who has no binding contract with them. In all other professions only their statuary councils determine their fees, not an insurance service.

    When it comes to professional services the accuracy of advice given is not directly proportional to the number of opinions sought. If a professional is pressurized enough, the temptation to give inaccurate advice that happens to suit the client's (patient's) bias unfortunately increases. There is nothing wrong with seeking second and even third opinions if in doubt, but choose carefully.
    You can be so polite

    Stan - I hear you and you are raising very good points. My point really was this: People don't like paying for legal advice either. It's not only the doctors that have a problem.

    I have great respect for the medical profession. But I still believe I have the freedom of choice if I can't or won't pay a quoted fee. (for any service for that matter)

    And medical aids - my pet hate.
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  10. #46
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    Default Re: There are good well priced doctors and not greedy

    Quote Originally Posted by Francois Theron View Post
    To take the analogy of surgeons vs say mechanics a bit further. As a mechanic (or any other trade) you can increase your income by hiring extra help and pay them x and charge x+y for that. That is basically how most people go foward. Although it does happen in the medical world, it is not as straight forward. So over time (for lack of a better term) is almost mandatory.
    I am going to extend the analogy even further than that.

    A mechanic's quality of work and fees charged are not governed by any statutory governing body nor can any mechanic be subjected to malpractice enquiries in that regard. Mechanics are not subject to a code of ethics and cannot be removed from any roll of mechanics for negligence.

    If a doctor botches a surgery - it could have millions upon millions of Rands in consequences, apart from an enquiry to establish whether the doctor is still fit and proper to practise medicine.

    If a mechanic botches a repair, the consequences are miniscule in relation to that of a medical doctor.

    I am by no means knocking the mechanical trade - but there is a massive difference between the two.
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  12. #47
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    Default Re: There are good well priced doctors and not greedy

    Quote Originally Posted by River Rat View Post
    ......The business model that makes sense is to rather reward the surgeon based on outcomes which means a basic fee for the procedure and an agterskot from the MA if there are no re-admissions in say a year.......
    One has to be careful not to build in any perverse financial incentives when it comes to medical services.
    By their nature certain procedures carry more risk for both the patient and the surgeon. If their lower success rate and higher complication rate would be punished remuneration-wise, then some surgeons would be tempted to rather direct those patients to colleagues.
    One does not want specialist surgeons tending to cherry pick the easier cases because of any punitive model.

    Do you know that in many cases the surgeon is paid X amount for say an appendisectomy, no matter how many days the patient might spend in hospital, a package fee? However re-operations for complications can be billed for as one would not want any perverse reason for not re-operating where necessary. All surgeons have complications, the better ones just have fewer complications. At the end of the day a surgeon is referred cases based on his reputation for producing good results. Live by the sword........

    I must say that this thread has produced many really positive posts, although I am obviously biased.
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  14. #48
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    Default Re: There are good well priced doctors and not greedy

    Quote Originally Posted by Stan Weakley View Post
    Surgeons make their livings from doing operations but at the end of the day they depend on the results of the operations they carry out for reputational success. They also garner self-satisfaction, professional pride and confidence from satisfactory surgical results. So again, their reluctance to promise a surgical solution bears a message in itself.
    To paraphrase
    You earn your living operating and your reputation not operating

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  16. #49
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    Default Re: There are good well priced doctors and not greedy

    Quote Originally Posted by MANDREAS View Post
    I am going to extend the analogy even further than that.

    A mechanic's quality of work and fees charged are not governed by any statutory governing body nor can any mechanic be subjected to malpractice enquiries in that regard. Mechanics are not subject to a code of ethics and cannot be removed from any roll of mechanics for negligence.

    If a doctor botches a surgery - it could have millions upon millions of Rands in consequences, apart from an enquiry to establish whether the doctor is still fit and proper to practise medicine.

    If a mechanic botches a repair, the consequences are miniscule in relation to that of a medical doctor.

    I am by no means knocking the mechanical trade - but there is a massive difference between the two.
    Which sadly, is where we are now at in SA. Compared to Europe, with the numerous guilds and so on, it would be impossible to get a job in a trade in Germany for instance, if one isnt qualified/certified. If a person does operate in a trade without the necessary papers, there are measures in place to redress the practice.
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  18. #50
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    Default Re: There are good well priced doctors and not greedy

    Quote Originally Posted by Stan Weakley View Post
    One has to be careful not to build in any perverse financial incentives when it comes to medical services.
    By their nature certain procedures carry more risk for both the patient and the surgeon. If their lower success rate and higher complication rate would be punished remuneration-wise, then some surgeons would be tempted to rather direct those patients to colleagues.
    One does not want specialist surgeons tending to cherry pick the easier cases because of any punitive model.

    Do you know that in many cases the surgeon is paid X amount for say an appendisectomy, no matter how many days the patient might spend in hospital, a package fee? However re-operations for complications can be billed for as one would not want any perverse reason for not re-operating where necessary. All surgeons have complications, the better ones just have fewer complications. At the end of the day a surgeon is referred cases based on his reputation for producing good results. Live by the sword........

    I must say that this thread has produced many really positive posts, although I am obviously biased.
    As it turns out, I am well versed with the packaged fee model and most of my responses are informed by this and I'm also aware that surgeons that discharge their patients quicker than the norm are not the favored by some hospital groups in terms of their tier system. The ratio of theater time versus hospital dwell time is unfortunately what drives most of the industry despite the normal value based platitudes you get from the major groups. Nonetheless, the business analyst in me says that the industry could do far better if the outcomes were paramount in structuring the reward and what I am suggesting speaks to a bonus in terms of good outcomes as opposed a punitive structure as you have highlighted. My analysis of certain procedures shows that if one takes just a % of the cost of re-admission to get the surgeon to focus on his outcomes and improve these it makes business sense for all involved. Of course as you point out there is a risk that certain less ethical surgeons could manipulate their own re-admission rate for financial gain but medical aids are well equipped system wise to identify these so they will not last.

    On a more strategic note as much as I despise government intervention the NHI is going to be the catalyst for change in the industry by introducing a competitive slant to this conversation in terms of fees, my fear is that outcomes are not taken into account.

  19. #51
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    Default Re: There are good well priced doctors and not greedy

    I'm surprised nobody has yet touched on the issue of insurance a surgeon needs in order to practice and the cost thereof

    The premiums are close to R 1 million per year in some cases. I image this cost gets passed down to the consumer as in most other businesses

    https://www.medicalbrief.co.za/archi...ctice%20claims.


    “So, what we are saying is that before you have earned a cent in your pocket to pay for your staff or your surgery or your water and lights or your children’s school fees, you’ve got to earn R1m to cover your insurance,” said Justin Malherbe, a health-care and insurance lawyer at Norton Rose Fulbright. “What makes that so significant is it jumping up in the last four years from R250,000 to R330,000 to R650,000 to R850,000 and now just approaching R1m. That is scary.”

    So the reason for high surgeon costs is really because of the lawyers and there after insurance firms taking advantage of a potential life and death situation.
    Last edited by Karol; 2021/05/12 at 12:54 PM.


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  21. #52
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    Default Re: There are good well priced doctors and not greedy

    Quote Originally Posted by Stan Weakley View Post
    All surgeons have complications, the better ones just have fewer complications. At the end of the day a surgeon is referred cases based on his reputation for producing good results. Live by the sword........
    Having recently (over the last 2+ years) had significant exposure to what one would probably call high-end surgery for my son, I can only agree wholeheartedly. We were referred to a specialist surgeon in CT who has an excellent reputation in bone tumors. This entailed my wife and I alternately "moving" to CT for a few weeks each as he couldn't fly or drive and he would need to have a few checkups before coming home. The surgeon's reputation made that worth the hassle.

    First procedure wasn't successful, but we were aware of the risk and opted to try it anyway as it would have been far less intrusive if it worked. So far, 2nd procedure has been successful although recovery is an ongoing nightmare.

    I've learned that reputation in a relatively small and close field really does matter.
    I've learned that paying way over medical aid rates can be completely worth it.
    I've learned that medical aids are sharks.
    I've learned that custom prosthetics are amazing.
    I've learned that I don't want to live in CT.
    I've learned that I'm going to be broke for a few more years still...

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  23. #53
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    Default Re: There are good well priced doctors and not greedy

    Chris I know how very tough it is to face potentially life threatening health problems in one's offspring. May it all be smooth sailing ahead for the Ainslies.
    Stanley Weakley.
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  25. #54
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    Default Re: There are good well priced doctors and not greedy

    Quote Originally Posted by Karol View Post
    I'm surprised nobody has yet touched on the issue of insurance a surgeon needs in order to practice and the cost thereof

    The premiums are close to R 1 million per year in some cases. I image this cost gets passed down to the consumer as in most other businesses

    https://www.medicalbrief.co.za/archi...ctice%20claims.


    “So, what we are saying is that before you have earned a cent in your pocket to pay for your staff or your surgery or your water and lights or your children’s school fees, you’ve got to earn R1m to cover your insurance,” said Justin Malherbe, a health-care and insurance lawyer at Norton Rose Fulbright. “What makes that so significant is it jumping up in the last four years from R250,000 to R330,000 to R650,000 to R850,000 and now just approaching R1m. That is scary.”

    So the reason for high surgeon costs is really because of the lawyers and there after insurance firms taking advantage of a potential life and death situation.

    I always wondered about this cover.
    Is this cover for example for if you go in for a shoulder operation and the surgeon cuts off your leg in other words gross negligence, or is it for if you go for a shoulder operation and in the process a nerve gets damaged there by leaving you with a semi permanent or permanent impairment of say your fingers, so more of a accedent or mistake by the surgeon?
    "The problems we have today is because the guys who work for a living are outnumbered by those who vote for a living." - Magnus Heystek

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  27. #55
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    Default Re: There are good well priced doctors and not greedy

    Quote Originally Posted by Karol View Post

    So the reason for high surgeon costs is really because of the lawyers and there after insurance firms taking advantage of a potential life and death situation.

    I can take this further for you.

    If it was not for the surgeons themselves (especially those with a CV as long as your forearm) that testify against other surgeons as expert witnesses, to point out where the "lesser" surgeon stuffed up, the costs would not be so high.
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  29. #56
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    Default Re: There are good well priced doctors and not greedy

    Quote Originally Posted by bigboy529 View Post
    I always wondered about this cover.
    Is this cover for example for if you go in for a shoulder operation and the surgeon cuts off your leg in other words gross negligence, or is it for if you go for a shoulder operation and in the process a nerve gets damaged there by leaving you with a semi permanent or permanent impairment of say your fingers, so more of a accedent or mistake by the surgeon?
    Both, however very few claims in SA are related to gross negligence or mistakes but rather around worse than expected outcomes. 95% never get to court and it ends up paying for a whole lot of lawyers fees.

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  31. #57
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    Default Re: There are good well priced doctors and not greedy

    Quote Originally Posted by Karol View Post
    I'm surprised nobody has yet touched on the issue of insurance a surgeon needs in order to practice and the cost thereof

    The premiums are close to R 1 million per year in some cases. I image this cost gets passed down to the consumer as in most other businesses

    https://www.medicalbrief.co.za/archi...ctice%20claims.


    “So, what we are saying is that before you have earned a cent in your pocket to pay for your staff or your surgery or your water and lights or your children’s school fees, you’ve got to earn R1m to cover your insurance,” said Justin Malherbe, a health-care and insurance lawyer at Norton Rose Fulbright. “What makes that so significant is it jumping up in the last four years from R250,000 to R330,000 to R650,000 to R850,000 and now just approaching R1m. That is scary.”

    So the reason for high surgeon costs is really because of the lawyers and there after insurance firms taking advantage of a potential life and death situation.
    This is what happens if you spend too much time in the Trump and Biden threads...
    Cheers
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  33. #58
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    Default Re: There are good well priced doctors and not greedy

    Quote Originally Posted by New View Post
    I can take this further for you.

    If it was not for the surgeons themselves (especially those with a CV as long as your forearm) that testify against other surgeons as expert witnesses, to point out where the "lesser" surgeon stuffed up, the costs would not be so high.
    I wonder if there is anyone clever enough in this world to testify against Karol.
    Cheers
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  34. #59
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    Default Re: There are good well priced doctors and not greedy

    Quote Originally Posted by River Rat View Post
    Both, however very few claims in SA are related to gross negligence or mistakes but rather around worse than expected outcomes. 95% never get to court and it ends up paying for a whole lot of lawyers fees.
    Medial negligence not being my forte, but don't you sign a indemnity for these procedures? That would nullify "just plain ol negligence" which means that the only claims they would actually end up being held accountable for is gross negligence (it being established that you cannot indemnify someone for gross negligence)?
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    Default Re: There are good well priced doctors and not greedy

    Quote Originally Posted by Stan Weakley View Post
    To both Tedx2 and JohnnoK, dare I say forum "friends" of mine Thank you, sir!, I do have some words of explanation on behalf of my profession. (Self-appointed spokesperson ) I can think of none better.

    To both of you please regard the reluctance of surgeons to operate under the circumstances and for the conditions you describe, as in itself conveying a definite message. Surgeons make their livings from doing operations but at the end of the day they depend on the results of the operations they carry out for reputational success. They also garner self-satisfaction, professional pride and confidence from satisfactory surgical results. So again, their reluctance to promise a surgical solution bears a message in itself. Noted, and appreciated. I garner my pride in releasing a serviceable aircraft, so I fully understand. I also know there are some snags that are beyond my ken, and they get referred to those with more experience/knowledge.

    A warning, a quick-fix solution might not be possible for the two complex malaises described and again therein lies a message to be seriously considered. Allow me to assure you that if you look hard enough you will find some cowboy willing to carry out surgery with little regard for the ultimate outcome. That is how life works. My "issue" is that my problem is "mechanical" in nature and no amount of medication is going to regenerate my cervical discs, I KNOW that the only long term fix is a fusion, and I am reasonably clued up on the risks involved.
    What burns my arse is being fobbed off with a script for a medication that has some nasty side effects (Lyrica) that I have seen first hand from my wife taking it. I'd be happy if the guy told me he couldn't offer any help beyond pain releif, but he never even went there.

    I often hear the words..."Surely in this day and age....". I would like to point out that the mysteries of the human body are still very far from being unraveled and there are huge numbers of medical discoveries yet to be made. Consider that in this age of men on the moon and the like, not even the simplest human organs can be manufactured to effectively serve as human spare parts. 100% agree that there is a lot to learn, but I still take offense at being charged R2400 for a script, which is effectively what happened that day.

    Unfortunately I think we have to accept that medical science still has many areas of uncertainty and one needs to respect expert medical opinion when uncertainty prevails.
    As the child of a Professional Nurse, I do have a lot of respect for the Medical Profession, but I am also not blind to the faults of those who are there to treat certain patients with a gold plated stethoscope because they have the means to pay for it, nor those who peddle pills as a way of keeping the patients coming back for ever more pills....






    the stethoscope story is Gospel Truth, the Doctor admitted it in conversation.....
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