Medical schemes industry thrown lifeline

Health minister Zweli Mkhize
Health minister Zweli Mkhize
Image: File

While the national treasury is still working out how much National Health Insurance (NHI) will cost, the latest version of the bill has thrown the medical schemes industry a lifeline.

The bill was released at a media conference on Thursday.

It was welcomed by the World Health Organisation‚ the SA Medical Association‚ pharmacies‚ the Board of Healthcare Funders‚ representing some medical aids‚ and the Life Hospital group.

Health minister Zweli Mkhize said the treasury was working on a financing paper and there “would be a further update”.

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For the time being, medical aid schemes are breathing easier.

That is because the bill, as it stands, means they will be able to continue until the ambitious scheme for universal health coverage is fully implemented.

The transition is also likely to give comfort to consumers who currently use medical schemes to pre-fund their access to private healthcare services.

At that stage, they will be restricted to offering cover for “complementary” services not covered by NHI.

The bill paves the way for the establishment of an NHI Fund, which will purchase services on behalf of patients from accredited public and private healthcare providers.

The bill says NHI is to be phased in, and is to be fully implemented by 2026.

The health department’s deputy director-general‚ Anban Pillay‚ explained that a payroll tax on both employers and employees‚ and a surcharge on personal income tax‚ would be used to fund NHI. This would be in addition to current taxes.

Pillay said: “Parliament will each year vote on what funds will be made available.”

Asked how taxes would be increased‚ given SA’s tight fiscal environment‚ Pillay said, initially, new money and new tax hikes were not needed.

“The question is‚ can we take money we are spending and use it more efficiently?”

Mkhize said: “Medical aids will have no trouble adapting to the changing environment, by developing products and services that provide complementary cover.”

The medical schemes industry provided cover to 8.87 million people at the end of 2017, according to the Council for Medical Schemes’ most recent annual report.

At that stage, this represented about 15.6% of the population.

SA’s biggest medical scheme administrator, Discovery Health, said it was studying the implications of the bill for the future role of medical schemes.

“We firmly believe that once South Africans have contributed to the NHI, they should have the freedom to purchase cover through medical schemes for any healthcare services, including those provided by the NHI, should they wish to do so,” said Discovery chief executive Jonathan Broomberg.

Medical schemes are also anxious about their prospects for contracting with the NHI Fund.

Aquina Thulare, who works in President Cyril Ramaphosa’s NHI “war room”, dashed these hopes, saying the bill made it clear that the NHI Fund was to be publicly administered.

For some, the bill still raises many questions.

“How will you control every one of the 57 million citizens from registering solely at private hospitals because who would want to use the government clinics anymore?” one man asked.