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‘Low-cost benefit framework could give a third of South Africans access to basic private health care’

Up to 20 million low-income South Africans could afford basic private healthcare services if the Council for Medical Schemes (CMS) developed a framework for low-cost benefit options (LCBO), according to Business Day.

The CMS was tasked with developing a LCBO framework after the government after demarcation regulations came into effect in April 2017. The framework will allow medical schemes to offer options that are exempt from providing the prescribed minimum benefits.

Read: Another reprieve for insurers that provide primary healthcare policies

According to Business Day, Insight Actuaries & Consultants joint-chief executive Christoff Raath told the Board of Healthcare Funders (BHF) conference last week that the CMS’s prevaricating over the LCBO framework has left millions of people from poor households paying out of pocket for private primary healthcare services, such as GP consultations and dentistry, because they cannot afford full medical scheme cover.

While 15% of the population belongs to a medical scheme, the 2020 general household survey found 28.2% of the population turned first to a private healthcare provider when they needed care.

“These are the families that can least afford R400 or R500 to go to a doctor. The question we have to ask is why is nothing being done about it?” Raath was quoted as saying.

The advisory committee established by the CMS in 2020 to finalise the LCBO framework had completed its technical work, and there was no need for further consultation, he said.

About 10 million people from low-income households could be covered by low-cost benefit options, which had been priced at between R124 and R166 a month. If National Treasury scrapped medical scheme credits and used the money to provide a R100 monthly grant towards low-cost benefit cover, the figure could rise to 20 million people, or a third of the population, he said.

Speculation that the ANC had put pressure on the CMS to put the brakes on the LCBO framework because it might pose an impediment to National Health Insurance (NHI) would be a “moral tragedy” if true, he said.

According to Business Day, it has previously asked the CMS registrar Dr Sipho Kabane whether the regulator was deliberately stalling LCBO while the government developed NHI. “In a recent interview, Kabane said the CMS had no ulterior motive and would like to wrap up the LCBO process as quickly as possible,” the publication reported.

Read the full Business Day report

‘Unions and members at odds over NHI’

Another Business Day report on the BHF conference said that public sector unions that support the NHI Bill “are poised for conflict with their members, as they have, in effect, given the green light for a reduction in employee benefits”.

The Bill proposes a central NHI Fund that will buy services on behalf of patients, financed by reallocating medical scheme tax credits, general tax revenue, and a new payroll tax and surcharge on personal income tax.

“Organised labour has been vociferously against increases in VAT, yet they are saying they support increased taxation to fund NHI,” the newspaper quoted Vishal Brijlal, director of the Clinton Health Access Initiative, as telling delegates.

Presenting an analysis of the 117 oral submissions made to Parliament’s Portfolio Committee on Health in the past year, Brijlal cited the submission of the National Education, Health and Allied Workers’ Union (Nehawu) as an example. Nehawu has said the government should scrap the tax rebate for medical scheme members, and redirect the money to the NHI fund, according to Brijlal.

Business Day reported that Cosatu’s parliamentary co-ordinator, Matthew Parks, said Brijlal had misunderstood the submissions of the trade union federation and its affiliates.

“He is welcome to talk to our members. We know there would have to be compromises. Whenever you are dealing with human beings, there are competing interests. The whole point is how to balance them,” Parks was quoted as saying.

“Unions have long been champions of NHI because their members are being bled dry by medical scheme co-payments and running out of day-to-day benefits.”

The Portfolio Committee on Health last week voted 7-4 in support of a motion of desirability of the NHI Bill, paving the way for its members to begin clause-by-clause deliberations on its content. The motion was supported by the ANC and IFP, but not by the DA, EFF and FF+.

Read the full Business Day report

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