SA health fund association anticipates positive report on costs in sector

The association says it expects the recommendations in the report to promote the sustainability of the healthcare funding industry.

South Africa’s Health Funders Association (HFA) says it anticipates a positive provisional report when the Competition Commission’s health market inquiry into drivers of costs in the private healthcare sector releases its findings.

The HFA, which represents 53 percent of South Africa’s medical scheme principal members, said it expected the recommendations in the report to promote the sustainability of the healthcare funding industry and contribute to the effective pursuit of universal health coverage in the best interest of all South Africans.

The government has published the National Health Insurance (NHI) and Medical Schemes Amendment bills aimed at making affordable healthcare available to all South Africans.

While the Medical Schemes Amendment bill seeks to make private healthcare more affordable by removing copayments on certain benefits and adjusting when waiting periods can be applied, these provisions in isolation have the unintended consequence of threatening the sustainability of medical schemes, HFA CEO Lerato Mosiah said.

“It is important to understand that medical schemes utilise risk management measures in order to ensure that they remain viable,” Mosiah said.

“Tampering with these limited measures in isolation would accelerate the erosion of reserves and leave medical schemes with very few options to maintain sustainability.”

She said desirable recommendations from the health market inquiry report could include a mechanism for negotiating doctors’ and hospital charges more effectively and mandatory medical scheme membership for people earning above a certain threshold.

The HFA says legislation governing medical schemes, despite its limitations, has been successful in ensuring that members are safeguarded in several ways, including provisions in the Medical Schemes Act to ensure that members are not discriminated against according to their risk and age profile and that every member is entitled to a specified set of hospital, emergency and chronic benefits.

It says these provisions which protect consumers, should have been counterbalanced in the Act by provisions which keep medical schemes sustainable to ensure ongoing protection of consumers, including compulsory membership, a risk equalisation mechanism and a framework for healthcare tariffs.

“Medical schemes have a bigger and critical role to play in increasing access to quality healthcare for more South Africans. Between medical schemes, doctors and hospitals there is sufficient data to be able to publish information on quality which would enable consumers to make educated choices when it comes to choosing their healthcare provider,” Mosiah said.

“It is, therefore, my hope that the health market inquiry recognises this and makes recommendations to government to enable a sustainable industry that contributes to long-term benefits to consumers of healthcare products and services.”

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