Medical aids come to party

Medical aid schemes will not only be legally obliged to fund Covid-19 vaccine for their about seven million adult members, the sector has agreed to a pricing arrangement to subsidise vaccination for the priority population without medical aid cover.

The surplus funds generated by the sector through higher price purchases of the vaccines will be used to cross-subsidise higher-risk nonmedical-scheme members, on a one-for-one basis.

This could result in the private sector funding the vaccination of about seven million higher-risk people not on medical aid.

“For each vaccine procured for a medical scheme member, sufficient surplus is generated through procurement arrangements for the vaccine to subsidise the vaccination of one nonmedical scheme member,” said Dr Ryan Noach, chief executive of Discovery Health.

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He said at this stage the available vaccines globally were only suitable for adults and that the focus would be on vaccinating approximately 7.1 million adult medical scheme members across the industry, including approximately two million adult members of the Discovery Health Medical Scheme.

According to Noach, this approach to medicine pricing was not unusual considering that many medicines were sold at a higher single exit price to the private healthcare sector than to the public health sector.

“This is undoubtedly a moment in time where solidarity in the healthcare sector is of paramount importance to the country and is warmly welcomed and supported by both the public and private sectors,” he said.

On the vaccine choice, Noach said a single-dose vaccine was preferable as these were significantly simpler to distribute and manage.

Also, compliance levels and consequently therapeutic efficacy was significantly higher for single-dose vaccines in comparison with multiple-dose vaccines.

“The need for tracking and tracing for follow-up of a second dosage is obviated. Typically, people either forget or neglect to follow-up on subsequent doses for multiple dose vaccines.

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Immunity at population level is achieved quicker with a single dose, considering that this amounts to the full vaccination regime, at first injection,” he said.

Dr Lungi Nyathi, Medscheme’s managing executive for clinical risk and advisory, said they were closely watching advancements in the acquisition of the vaccine to ensure members were funded.

“As one of the three pillars ofthe anticipated funding process,we support the multipronged funding approach and believe it is the most practical,” she said.

Dr Sipho Kabane, Council for Medical Schemes (CMS) chief executive registrar, said they had been coordinating public-private sector collaborations to ensure universal access to a Covid-19 vaccine, in line with SA’s priorities and individual health needs.

“As such, the Covid-19 vaccine has been included in the amended prescribed minimum benefit regulations, approved by Minister of Health Dr Zweli Mkhize.

“This amendment includes the insertion of the diagnosis and treatment pair in the list of prescribed minimum benefits under the heading Respiratory System Treatment: screening, clinically appropriate diagnostic tests, vaccination, medication, medical management including hospitalisation and treatment of complications, and Covid-19 rehabilitation,” he said.

Kabane said the collaborative approach was aimed at supporting the national effort of achieving a herd immunity of 67% and more through the equitable access to the vaccine.

He acknowledged there may be an additional cost burden to medical schemes for the provision of the vaccine but said this was not expected to be prohibitively high.

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Kabane said industry associations have also assured the CMS that vaccine costs can be absorbed by most medical schemes.

However, he said there were several issues that needed exploration and discussion before there was agreement on them, including criteria on prioritised populations, clinical guidelines and protocols, prevention of fraud, waste and abuse.

Mkhize has said that more than 40 million South Africans, or 67% of the population, were targeted to receive the Covid-19 vaccine by the end of the year.

– siphom@citizen.co.za

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