Health­care com­pe­ti­tion in­quiry widened

Weekend Argus (Saturday Edition) - - PERSONALFINANCE - LAURA DU PREEZ

The Board of Health­care Fun­ders (BHF), which rep­re­sents med­i­cal schemes and their ad­min­is­tra­tors, has wel­comed the ex­pan­sion of the terms of ref­er­ence of the Com­pe­ti­tion Com­mis­sion’s in­quiry into the pri­vate health­care sec­tor.

The Com­pe­ti­tion Com­mis­sion has fi­nalised the terms of ref­er­ence and pub­lished them in the Gov­ern­ment Gazette.

It says the in­quiry will start on Jan­uary 6 and be com­pleted by Novem­ber 30, 2015.

The re­vised terms of ref­er­ence state that the in­quiry will con­sider “the ex­tent to which the reg­u­la­tory frame­work achieves the ad­e­quate func­tion of the mar­ket for health insurance”.

The in­quiry will also look into the in­flu­ence of the cur­rent laws and reg­u­la­tions on health in­sur­ers and pri­vate health insurance to re­spond to the de­mand for health care.

At a re­cent BHF con­fer­ence, in­de­pen­dent ac­tu­ary Christoff Raath, of the Health Mon­i­tor Com­pany, de­scribed the med­i­cal scheme in­dus­try as “a reg­u­la­tory or­phan”, be­cause gov­ern­ment’s fail­ure to im­ple­ment cer­tain re­forms has made med­i­cal scheme mem­ber­ship in­creas­ingly un­af­ford­able.

In par­tic­u­lar, med­i­cal schemes are obliged to pro­vide cer­tain min­i­mum ben­e­fits that must be paid for in full no mat­ter what the ser­vice provider charges. And open schemes must ad­mit any­one who wants to join with­out set­ting con­tri­bu­tions in line with your state of health or age.

How­ever, there is no com­pul­sory mem­ber­ship of med­i­cal schemes and, as a re­sult, younger, healthier peo­ple do not join schemes un­til they need med­i­cal care.

It is es­ti­mated that schemes could be 30 per­cent cheaper if scheme mem­ber­ship was com­pul­sory for all em­ployed peo­ple, and other mea­sures, such the cross­sub­sidi­s­a­tion of costs across schemes and in­come groups, were in­tro­duced.

The BHF says it is also en­cour­aged that the med­i­cal equip­ment, con­sum­ables and phar­ma­ceu­ti­cal in­dus­tries are listed specif­i­cally in the terms of ref­er­ence for the in­quiry.

The BHF’s man­ag­ing di­rec­tor, Humphrey Zok­ufa, says it is clear from the terms of ref­er­ence that the in­quiry will not fo­cus only on the costs of health care, but will also ex­am­ine ef­fi­cien­cies and qual­ity within the sec­tor.

Zok­ufa says it is ex­tremely im­por­tant that th­ese is­sues are re­solved, not only to en­sure the vi­a­bil­ity of med­i­cal schemes, but also be­cause they could pose a threat to the pro­posed Na­tional Health Insurance sys­tem.

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