Board of Healthcare Funders (BHF) executive director Humphrey Zokufa has urged the medical schemes industry to fight “to the bitter end” in support of the government’s proposed changes to regulation 8‚ a fiercely contested piece of legislation governing the extent to which medical schemes must cover their members’ bills.
Two weeks ago‚ Health Minister Aaron Motsoaledi published draft amendments to the regulations to the Medical Schemes Act‚ which propose limiting medical schemes’ financial liability for prescribed minimum benefits‚ changes critics say expose patients to potentially big co-payments for serious illness.
The BHF‚ an industry association for medical schemes and administrators‚ has lobbied for years for the changes. It says the current rules requiring schemes to pay in full for prescribed minimum benefits regardless of what doctors and hospitals charge means they face an unsustainable‚ open-ended liability.
The proposed changes to regulation 8 had been fiercely attacked in the media by critics who felt they were adversely affected by it‚ but would be defended tooth and nail by medical schemes‚ said Zokufa.
He was speaking at the BHF annual conference taking place this week.
“That regulation is going to be fought to the bitter end. That is the reality‚” he said.
He said the industry had been too passive in the face of a ruling by the Competition Commission in 2003 prohibiting collective bargaining between funders and service providers‚ to its detriment‚ and needed now to rally and support the minister’s proposals.
Prescribed minimum benefits are a basket of healthcare services medical schemes must provide to members on any benefit package. They include 270 medical conditions‚ 25 chronic conditions‚ and emergency care. It has been a fiercely contested aspect of healthcare legislation for years and is being challenged in the High Court in Cape Town by Cape-based medical scheme Genesis.
While the draft regulations limit schemes’ responsibilities for paying for prescribed minimum benefits‚ they do not restrict what a doctor or health provider may charge. Patient advocacy groups and doctor organisations have expressed concern that patients could face financially catastrophic co-payments.
The Treatment Action Campaign said on Monday that while there were legitimate concerns about the high cost of private healthcare‚ limiting medical scheme coverage for prescribed minimum benefits was not a sensible solution.
There was evidence that patients faced financial ruin when forced to pay or co-pay for prescribed minimum benefits‚ it said‚ citing a family that had exhausted its finances to pay for treatment for a child with Crohn’s disease because their scheme would not pay.
“Many patients with mental health conditions will not be able to afford the medicines they need and will land up in hospital with even more serious conditions‚” said Cassey Chambers of the South African Depression and Anxiety Group.
Linda Greeff‚ of People Living With Cancer‚ said: “Many cancer treatments will simply be out of reach for anyone without the guarantee of payment.”