The National Health Insurance (NHI) is not a radical shift to dismantle a functioning system, but an opportunity to review two poorly functioning ones.
The public sector sees very high volumes of patients but gives them bad service and produces very poor outcomes. The private sector is modelled on low volume, high cost care – it uses its huge quantities of resources badly, to service very few people.
As the Health Market Inquiry (HMI) report makes clear, the large commercial medical schemes are resisting needed reforms that with better productivity would lead to the convergence of the two systems. In particular, they persist with an outdated tariff system that pays for services not outcomes and doesn’t support team-based delivery models. This is probably because it threatens their claim payment and ‘managed care’ role that justifies a very high income. This strategy is counterproductive for their members.
If a service is provided by a company rather than government, this does not automatically mean a market is at work. The point is fairly obvious but has passed many in South Africa by.
Private provision of services is moving into the spotlight in South Africa as the government looks to make the health system more accessible to the poor. One aspect is the Health Market Inquiry, established by the Competition Commission and chaired by former Chief Justice Sandile Ngcobo. It recently released a provisional report recommending more regulation of private healthcare. It has invited comment on its ideas.
It is absolutely inevitable that whatever proposals it comes up with will be attacked as an assault on the free market in health care. This will ignore the reality – that there is no market in healthcare in South Africa, at least not one which works in the way in which markets are meant to work.
Has the almost simultaneous release of the National Health Insurance (NHI) Bill, the Medical Schemes Amendment Bill and the provisional findings of the Health Market Inquiry (HMI) created an information overload, where some of the insights from the inquiry could be lost in the noise?
“There is significant risk that the regulatory environment being created through the legislative amendment process currently underway could conflict with the lessons learned in the course of the HMI’s work, which will only be fully apparent on the release of its final report,” says Mark Arnold, principal officer of Resolution Health Medical Scheme.
A considerable amount of time, resources and expertise have been invested in the HMI, but with the final report due for release in November, however, there is a risk that the full benefit of these insights could be lost due to the timing of these inter-related developments, as the period for submissions on Medical Schemes Amen Continue reading…
While the proposed amendments to the Medical Schemes Act seek to lower the cost of private healthcare, they may have the unintended consequence of threatening the sustainability of medical schemes.
The amendments look at abolishing the practice of copayments on certain benefits, removing waiting periods and prescribed minimum benefits and tapping into the reserves medical schemes are required to hold.
These provisions in isolation could affect the financial stability of medical aids, says Lerato Mosiah, CEO: Health Funders Association (HFA). “Whilst we welcome the dialogue in the sector, it is critical that this takes into consideration the broader picture and context. It is thus important to understand that medical schemes utilise risk management measures in order to ensure that they remain viable.
Looking for a affordable Medical Aid or Hospital Plan, just click hereContinue reading…