Two recent articles in Business Day highlight the need for circumspection before implementing the demarcation proposals.
The Board of Healthcare Funders (BHF) pointed out that the affordability of medical schemes is seriously hampered by the unintended consequences of the introduction of Prescribed Medical Benefits (PMBs), which pushed up premiums. Their estimate is that the additional cost of PMBs increased medical scheme premiums by R800 per beneficiary, which makes medical schemes unaffordable for poorer households.
Research shows that this group prefers primary healthcare that provides cover for visits to general practitioners and dentists to hospital cover. Available health insurance products which are not regulated by the Medical Schemes Council cost around R250 to R300.
Christoff Raath, joint CEO of Insight Actuaries and Consultants, is quoted as saying that up to 4 million South Africans will be able to get “…access to private healthcare if medical schemes were allowed to provide a cheap, pared-down basket of benefits to low earners…”.
He is of the opinion that changes could be introduced as part of the National Health Insurance, which is being considered for the very purpose of improving the availability of quality healthcare to all South Africans.
In an earlier article in Business Day, Richard Blackman, CEO of Day1 Health, suggested that changes to the regulation of healthcare products should be delayed until the Competition Commission has completed its investigation into the private healthcare sector.
“The demarcation regulations have been awaited for six years … it is clear that (their) enactment at this stage will cut across matters which are squarely within the scope of the enquiry and will distort the market even while it is being investigated,” said Day1 CEO Richard Blackman in his submission to the Treasury.”
It is clear from the above that someone has to step in and coordinate all the proposed changes. It seems very likely that, unless this happens, contradictory amendments will have a domino effect and exacerbate the confusion that currently reigns, rather than provide clarity.
The two articles in Business Day can be read by clicking on the following links: