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Physician Heal Thyself

The Council for Medical Schemes (CMS) published its annual report on 3 September 2013.

The 5-page media release contains some very interesting statistics about trends in the industry, as well as a summary of highlights for the council in the 2012-2013 financial year.

Two concerns I have, yes three, while on a biblical theme. These quotes come directly from the media release:

  1. The Medical Schemes Act needs to be protected against health insurance products which threaten to undermine and even erode the provisions that speak to social security and protection of members’ rights. The CMS believes that any products which encroach on the business of the medical schemes industry need to be duly registered and regulated by the CMS to ensure that the public interest is preserved and even enhanced. Health insurance products such as gap and top-up cover discriminate against the most vulnerable groups in society. This is why the CMS continued to promote the protection of provisions aimed at protecting both the sick and the elderly.


  1. The prescribed minimum benefits stand and must be protected and strengthened to serve both beneficiaries and the entire health system. Non-compliance with PMB provisions in the Medical Schemes Act undermines the effectiveness and long-term sustainability of the medical schemes industry, and consequently threatens to undermine the national health system, both public and private. Medical schemes must ensure that they fully comply with all the provisions of the Medical Schemes Act at all times. One such provision is that on prescribed minimum benefits, or PMBs. Following the significant ruling against the Board of Healthcare Funders of Southern Africa (BHF) by the High Court and later the Supreme Court of Appeal, the CMS continued to protect and promote PMBs in all its endeavours. PMBs speak to the very heart of the Medical Schemes Act as they protect beneficiaries against unforeseen health events that could otherwise ruin them financially.


  1. Key amendments to the Medical Schemes Act are also required to ensure that brokers are regulated more effectively.


We invite readers to comment on the above, and share their thoughts on the following:

  • Did gap cover and top-up plans not develop as a result of watered-down benefits offered by medical schemes?
  • Prescribed Minimum Benefits appear to be abused by most sectors in the healthcare industry, some more so than others. Will effective price regulation, and stricter action against perpetrators of fraud, not do more to protect the public?
  • Should current legislation regarding regulation in the Medical Schemes Act not be more closely aligned with FAIS, rather than adding an additional layer of regulatory requirements?


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