A proud history

THE powers given to the Council for Medical Schemes (CMS) by the Medical Schemes Act has stabilised many of the negative tendencies of the private health sector. Past successes include:

Improvement of medical scheme coverage and its quality coverage, which was in decline during the 1990s;

Containment of the upward trend in private provider costs experienced by medical schemes, with 2010 costs per beneficiary per month only slightly higher than the 2006 levels.

Containment of non-health costs in medical schemes which increased dramatically post the de-regulation of January 1994 and only ended after the full implementation of the CMS in 2002.

Introduction of new solvency requirements which reduced the risk of rapid unforeseen insolvencies in schemes;

Introduction of web-based reporting of annual financial returns, with quarterly reporting introduced from around 2004, which improved the early warning and response capability of the office;

Substantially improved transparency in the system through an upgrading of the South African Institute of Chartered Accountants guidelines and the public reporting of medical scheme financials and data through the annexures to the annual report which are published annually on the website; and establishment of a robust complaints system and a call centre which afforded easy communication with the public.

The introduction of a real time web based monitoring application that collects a limited data set via direct mapping to the systems of medical schemes. This allows for better understanding of the risk profiles of schemes and thus more holistic regulatory and policy interventions.

In 2013, the CMS introduced a process for Alternative Disputes Resolution and facilitation of pro-bono legal assistance the following year to alleviate “administrative and financial pressures from the beneficiaries, schemes and the regulator.

“Although in their initial stages, these interventions have been welcomed by stakeholders and are certainly a move in the right direction,” says Acting chief executive and registrar Daniel Lehutjo.