Designated Service Provider Networks for EMS

According to the Medical Schemes Act, 1998, Regulations, Chapter 3: Contributions and Benefits, 7: Definitions, a Designated Service Provider is defined as: “…a health care provider or group of providers selected by the medical scheme concerned as the preferred provider or providers to provide to its members diagnosis, treatment and care in respect of one or more prescribed minimum benefit conditions…”

The use of a Designated Service Provider (DSP) network is intended to allow medical schemes to negotiate fair and sustainable tariffs between schemes and providers in order to manage and contain the cost of treatment to members of the respective medical scheme, within reasonable parameters.

But where does a scheme strike a balance between managing cost and ensuring that the members of the scheme have access to essential emergency medical treatment in the instance of a medical emergency?

When disaster strikes, or when an urgent inter-facility transfer is required, a patient often does not have the time or the facilities to access the internet, look up their DSP, contact the provider, and then wait anywhere between 30 minutes and four hours for the DSP to travel from a neighbouring town to assist the patient. The patient needs the first available and closest EMS provider in order to avoid extended pain and suffering, loss of bodily function, or even possible death.

A worryingly large number of South African Medical Schemes make use of only one Designated Service Provider for their emergency medical service needs; this despite the fact that there are in excess of one hundred quality private ambulance services across South Africa that are available to assist patients, and who are completely willing to contract with medical schemes on a Designated Service Provider basis.

The limited DSP network for ambulance services becomes increasingly concerning for patients that fall ill or are injured in outlying rural and semi-rural areas where the DSP has not stationed any ambulances. Despite DSPs telling the scheme that they have alternative service providers in those areas, in the case of inter-facility transfers, where the patient needs to be urgently moved from an outlying rural hospital to a specialist facility that can treat emergencies such as heart attacks, strokes, spinal injuries, and internal bleeding, we see such patients waiting hours for the DSP to travel from a neighbouring city to collect the them, instead of making use of a local provider who is immediately available to assist the patient.

The results of these completely unnecessary delays are often extended stays in ICU at increased cost to the scheme, long term disability to patients and in some cases – death.

As a medical aid member, does your medical aid scheme force you to only make use of one Designated Service Provider for ambulance services? If so, does your medical aid scheme really care about your well-being in the event of a medical emergency, or are they simply more concerned about saving money?

As a medical scheme, are you only utilising one primary Designated Service Provider for ambulance services? Would you like to hear an independent opinion on how many quality providers are actually available to assist your members across South Africa and how to contract with these providers in a structured and controlled environment? If so, please feel free to contact and allow us to assist you in providing the very best possible emergency medical service network to your scheme members!

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