Making healthcare affordable and equitable
The Medical Schemes Amendment Bill and the National Health Insurance Bill will address high healthcare costs, ensure the smooth running of the healthcare system and create equality
In an effort to address high healthcare costs, ensure the smooth running of the healthcare system and create equality, government has released the Medical Schemes Amendment Bill and the National Health Insurance Bill.
Druing a recent media briefing, Health Minister Dr Aaron Motsoaledi explained that the Medical Schemes Amendment Bill seeks to amend the Medical Schemes Act, 1998 (Act No. 131 of 1998) to align with the National Health Insurance White Paper and the National Health Insurance Bill.
“The first reason for this amendment is that the implementation of the National Health Insurance (NHI) is not going to be a once-off event but will take place in a phased-in approach. While this is happening, the population of medical schemes' beneficiaries need immediate relief from serious challenges experienced in the current medical scheme regime. The nature and magnitude of the challenges are that it will be undesirable for medical scheme beneficiaries to have to wait for long-term changes,” he said.
Access to healthcare
In addition, the amendment is intended to align the medical scheme environment to that which will exist under the NHI so that there is a smooth, harmonious transition that does not disrupt access to healthcare.
“As it is now generally accepted, the cost of private healthcare is out of the reach of many citizens, even the well-to-do ones,” the Minister noted.
The first amendment is to abolish what has come to be known as co-payments. Co-payments are when the scheme pays a portion of the bill that a provider (hospital or private doctor) charges a patient. The rest of the money is supposed to be paid by the patient from their own pocket.
Minister Motsoaledi explained that the amendment means that every cent charged to the patient must be settled fully by the scheme and the patient should not be burdened with having to pay.
“There are people who will scream that this amendment is outrageous and calculated to destroy medical schemes and leave beneficiaries with nothing. I wish to assure you that this was well thought of.The load of complaints received from the public by us, the Department of Health, as well as by the Council
for Medical Schemes – the medical schemes regulator – justifies this amendment,” he noted.
The Minister added that data showed that medical schemes were holding reserves of close to R60 billion that were not being used.
“Granted, there is a statutory requirement that medical schemes should have 25 percent of their income in reserve. This is to cater for emergencies. But presently the
R60 billion is equivalent to 33 percent reserves, which means unnecessary accumulation at the expense of patients.”
These huge reserves were accumulated partly through high premiums but also by introducing co-payments so that medical schemes avoid having to pay or even dip into the reserves if the situation demands, he explained.
Ensuring patients benefit
The Council for Medical Schemes is currently reviewing this statutory requirement of 25 percent with a view to release enough money for patients, rather than holding a lot of reserves while patients suffer the hardships.
Other amendments include: Abolishing the practice of using brokers within the medical scheme environment. Abolishing the practice of Prescribed Minimum Benefits and replacing it with comprehensive service benefits.
Dealing with various unequal and unfair benefit options which medical schemes are subjecting their members to. The amendment prevents any medical scheme from implementing any benefit option unless approved by the Registrar of the Council for Medical Schemes.
Declaring the carrying on of the business of a medical scheme by a person not registered as a medical scheme to be a specific offence.
The introduction of an income cross-subsidisation model. Compelling medical aid schemes to pass back savings if a member uses a designated service provider according to the rules of the scheme.
The cancellation of membership and waiting periods between joining a scheme and accessing benefits.
Quality health services
With regard to the NHI Bill, Minister Motsoaledi pointed out that the NHI is a health financing system that pools funds to provide access to quality health services for all South Africans based on their health needs and irrespective of their socio-economic status.
“It will need a massive reorganisation of the current health system, both public and private,” he said.
The Minister explained that the objective of the Act is to establish a fund that aims to achieve sustainable and affordable universal access to healthcare services by: Establishing and maintaining an efficient fund through the consolidation of revenue to protect users against financial risk.
Serving as the single public purchaser of health services in terms of this Act to ensure the equitable and fair distribution and use of healthcare services. Ensuring the sustainability of funding for healthcare services. Providing for equity and efficiency in funding by actively purchasing healthcare services, medicines, health goods and health-related products from certified, accredited and contracted service providers. According to the Minister, government has also identified 12 acts to be amended for the smooth running of the healthcare system and to guarantee or “impose quality”.
These include the National Health Act, 2003 (Act No. 61 of 2003) and the Mental Health Act, 2002 (Act No. 17 of 2002).
The public has three months to comment on the NHI Bill and the Medical Schemes Amendment Bill, which were published in the Government Gazette on 21 June.