What is the National Health Reference Price List NHRPL

    What is the National Health Reference Price List NHRPL?

    • This is a list of tariffs regarding health care professionals.
    • The government releases the NHRPL annually.
    • The Department of Health is reponsible for the list
    • It serves as a guideline for, not as an enforceable regulation of, rates.
    • Medical aids use it to determine how much they pay out.

    Each year the Department of Health published the National Health Reference Price List (NHRPL). The Department draws up the list, which serves as a guideline for the cost of medical procedures and fees for medical practitioners.

    Who uses the NHRPL?

    Medical professionals use the NHRPL as a guide as to what fees to charge. Alternatively, medical practitioners can also draw on the guidelines provided by the Health Professions Council of South Africa (HPCSA). Bear in mind that guidelines provided by the latter tend to be a lot higher and may be a more accurate reflection of costs.

    The HPCSA’s recommended rates average out at about 300% higher than the rates published in the NHRPL. The council bases its recommendations on what it believes is a reasonable rate. A medical professional may charge more but must tell their clients about the increased rate upfront.

    Medical professionals who charge a patient more without first informing them about the rate may be reported to the NHRPL or National Health Reference Price Listcouncil for sanction.

    Which Is More Realistic?

    Considering that the NHRPL bases its recommendations on national averages, it is highly possible that the HPCSA’s rates are more realistic. Some people say that the NHRPL rates are not sufficient to allow providers to provide a high standard of care and still earn a decent wage.

    The average medical cost for higher-quality providers has always exceeded the norm anyway. The better the level of care, the more you can expect to pay. Suppliers that offer better care are normally in greater demand and so are able to charge more because of the standard principle of supply and demand.

    In determining the average cost of medical care, compilers use much data. Averaging the costs nationally is not the most effective measure because costs can vary vastly from region to region.

    Why Do People Use the List At All?

    The list is a guideline for health care practitioners but medical schemes also use it to help determine their standard tariffs. Often medical schemes will make decisions on how much to pay per procedure based on this annual list.

    So, ultimately, this list is extremely important to consumers because it plays a role in not only how much they are charged but also in how much of the charge the medical aid will cover. That is why you see some medical aids advertising that they pay more than 100% of medical aid tariffs. There can be a discrepancy  between what they pay and what you are charged.

    Is This Set In Stone?

    The list is merely meant as a guideline. Practitioners and medical aids are under no obligation to follow these guidelines at all. There is no legislation that forces them to.

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