Medical aid companies still quiet on Motsoaledi’s amendments

A day spent trying to get official comment from medical aid industry leaders such as Discovery and Bestmed yielded very little, and even off-the-record comments seemed to come from people who were still processing what the changes could mean for their professions.

An insurance broker, who asked not to be named, said: “Aaron Motsoaledi is a man I have a lot of respect for, and I have no doubt his heart is in the right place, but the changes are extremely idealistic and I can’t see them being implemented without substantial trouble.

“We don’t know what kind of chaos to expect yet, but I very much doubt there won’t be any,” he added before trying to sell me insurance.

Dr Sipho Kabane, the acting chief executive and registrar of the Council for Medical Schemes, which was closely involved in the process that led to the amendments announced on Thursday, said he was confident the changes would be for the better and that implementation would not be as difficult as some had predicted. He in effect cautioned those in the industry to relax.

“We ourselves are still studying the relevant documents and we understand that not everyone will be happy with the changes,” the doctor said.

“If you think of medical aid schemes as non-profit entities, they should be happy with the changes. But those profiting from the current situation obviously won’t be happy,” added Kabane.

Health Minister Aaron Motsoaledi pointed out in a briefing explaining the changes yesterday that it is not legal for medical aid schemes to turn a profit.

Kabane agreed, saying: “They are meant to be non-profit entities who look after members interests.

“There are medical aid administrators who perform functions they earn money from, such as facilitating claims, who will be affected.”

But Kabane said people would have to engage with the Council for Medical Schemes if they had problems with the amendments.

“We expect that companies and individuals will interact with the bills and we will have to deal with any views they have about them.”

Asked if those involved with medical aid would simply raise prices in response to new amendments that decree, for example, that medical aid companies can no longer demand co-payments from their clients, Kabane said they would not be able to do so without going through the council first.

“As a regulator of all these entities, including the administrators, we regulate contributor increases. They can’t just increase prices.”

READ MORE: New SA medical aid amendments will change your life

I then asked about the National Health Insurance Bill, described as “a health financing system that pools funds to provide access to quality health service for all South Africans based on their health needs irrespective of their socioeconomic status”.

Motsoaledi says the desired outcome of the bill will be seeing “the rich subsidise medical aid for the poor, the young subsidise the elderly and the healthy subsidise the sick”.

I asked if Kabane foresaw a backlash from wealthier South Africans over this.

He stressed that this change would just mean greater implementation of principles that already exist.

“Already the young and healthy subsidise the old and sick by claiming less, and then this cycle repeats itself as those people in turn grown older.”

At the briefing, Motsoaledi mentioned rumours that certain groups were attempting to interdict the findings of an inquiry the minister has asked Justice Sandile Ngcobo to do into the rising costs of health care.

Kabane said: “One can speculate that those who are seeking the interdict stand to be affected adversely by the changes.”

Despite Kabane’s assurances, an informal poll on The Citizen today indicated that 35% of respondents believe the changes are “completely misguided and will destroy private healthcare”.

About a quarter of respondents said they were impressed with the changes, believing that it’s what the country needs, while 19% admitted that they had no idea what the changes even mean. Sixteen percent called the changes a “mixed bag”, while 5% said they “don’t care” because they think they’re effectively immortal.

The poll is still live and so the results are expected to change.

Notably absent from the debate so far are medical aid companies and brokers. With their ability to turn an arguably illegal profit in the balance, the silence of those who stand to lose money from Motsoaledi’s changes to South African health laws has been deafening.