NHI threat to govt medical aids

HEALTH INSURANCE: SECONDARY CARE IS ANSWER

Sinesipho Schrieber

The South African Police Service Medical Scheme (Polmed) has cautioned government-dependent medical aids to concentrate on secondary healthcare in order to survive the introduction of national health insurance (NHI), which is set to provide primary healthcare to all South Africans in 2025.

Polmed’s principal officer, Neo Khauoe, said they have not yet discussed with the state how civil service-based medical aid schemes should be able to survive after the introduction of NHI.

She believed that in order to coexist with the NHI, the schemes would be bound to offer specifically secondary healthcare, as NHI would deal with primary healthcare.

Khauoe said: “For medical schemes, the NHI poses a challenge, especially for us at Polmed because 75% of the contributions of the scheme comes from government to provide primary to tertiary healthcare for our members.

“We can survive within the healthcare sector by providing secondary and tertiary health care.”

Polmed, the second-biggest restricted medical scheme, caters for 500 000 beneficiaries who are members of the Saps and their families, including extended family members.

It remained hopeful that the introduction of NHI will not leave it in the cold.

Polmed is the only scheme where members’ dependants qualify for benefits up to age 30.

Referring to challenges faced by Polmed, Khauoe said defrauding of the medical aid scheme by members colluding with medical professionals was growing.

She said that in 2018, the medical scheme had 687 cases of fraudulent claims to the value of R204 million, but it was able to recover R60 million.

She blamed the justice system for being slow in dealing with reported cases.

Many cases were reported to the professional bodies to which the medical practitioners, who including doctors and nurses, were affiliated.

Many of these offenders have been disciplined, or struck from the roll.

Khauoe said: “We are currently in a process of profiling members that are linked to fraud claims.”

Regarding rampant gender-based violence involving Saps members, Khauoe said members had access to psychologists and Polmed also provided group counselling.