New board to oversee medical aid
GOVERNMENT will establish a regulatory board to superintend medical aid societies and ease tensions between healthcare funders and service providers.
The Medical Aid Regulatory Board could be appointed this year if Parliament passes the enabling law as recommended by the Health and Child Care Ministry.
Presently, the ministry oversees both parties and arbitrates disputes. This arrangement has, however, failed to end a stand-off that has now lasted for nearly a year and authorities reason a separate board could do the trick.
Health and Child Care Deputy Minister Dr Aldrin Musiiwa told The Sunday Mail, “Once this board is established, it will see to licensing and regulating medical aid societies. It will also settle disputes amicably, fairly.
“Only three officers have been dealing with numerous cases, and as the concerned ministry, we feel these officers are burdened. And as a result, we have not done justice to both medical aid societies and service providers when dealing with some of the disputes.
“There are a lot of inconsistencies in the law. Statutory Instrument 300 of 2000 has a lot of loopholes and is causing a lot of problems. It cites the Health and Child Care Minister as the regulator, there- fore, whenever there is a dispute between medical aid societies and service providers, the ministry is supposed to resolve them.”
Dr Musiiwa went on: “Under the coming dispensation, medical aid societies will have to seek authorisation to venture into service provision. The way (the present) legislation was crafted left a lot of loopholes.
“Medical aid societies are health funders, but could go into service provision, and all they need to do is inform the Secretary for Health and Child Care. This creates problems of competition because health insurers then target a certain location where the population of their members is large.
“They compete with service providers who, in turn, complained that health funders were withholding money that was due to them in order to build capacity and then compete with them.”
Regarding the long-running stand-off between doctors and medical aid societies, he said: “There has been a great improvement (in terms of claim payments), though (medical aid societies) have not paid off completely. The marked improvement has given provision for them to extend their licences up to December 2016. Some medical aid societies have gone as far as getting loans to pay off service providers.”