FANews
FANews
RELATED CATEGORIES
Category Healthcare
SUB CATEGORIES General  |  HIV |  Medical Schemes | 

Declaring war on medical schemes

17 August 2009 Gareth Stokes
Gareth Stokes, FAnews Online Editor

Gareth Stokes, FAnews Online Editor

The Sunday Times is often criticised for publishing articles with an anti-government slant. While the paper remains brave enough to publish details of political shenanigans, allegations of corruption and evidence of poor service delivery, this week’s assault on the country’s medical schemes industry is dripping with pro-government sentiment. The Sunday Times – and its readers – know that the African National Congress (ANC) has plans to implement a national health insurance (NHI) fund. Can we view the paper’s open condemnation of medical schemes as tacit support for government’s plan?

“Medical aid crunch hits SA families hard,” claim journalists Subashni Naidoo and Rob Rose in the paper’s lead article. They allege that “half of South Africa’s eight million medical aid members are either broke or fast running out of funds to cover day-to-day medical expenses.” The Sunday Times says that 70 % of ‘cheap’ medical aid members, 40% to 50% of ‘mid-level’ members and 20% of ‘top-end’ members had run out of funds by March of a particular calendar year. This information conflicts slightly with statistics provided by the country’s largest medical scheme, Discovery Health. They say that through 2008 17% of their members ran out of funds by May, with 42% in the predicament by September.

The major complaint

But ranting over the inefficient cover afforded by private medical schemes may soon be a thing of the past. An NHI solution looms, with both government and the Board of Healthcare Funders (BHF) indicating their support for a draft NHI proposal. The draft will be reworked in coming months; but regardless of future changes we expect a full scale implementation of NHI to render medical schemes obsolete, place an unacceptable burden on the country’s taxpayers and possibly destroy the private healthcare sector altogether. South African citizens who currently benefit from some form of private healthcare won’t be complaining about insufficient benefits in future; but insufficient services.

Medical schemes have been reluctant to comment on ‘leaked’ versions of government’s NHI policy, preferring to adopt a wait-and-see attitude. We expect schemes want to see an official government policy document before entering the fray. But after this week end’s press ambush the medical schemes may want to reconsider their positions. After all, they represent the interests of approximately eight million ordinary South Africans!

Will NHI be the death knell for medical schemes?

From a governance point of view we’re amazed the BHF – which is supposed to represent medical schemes’ interests – can back a proposal that circumvents their industry. According to an article published 1 August 2009 on MoneyWeb, BHF managing director, Humphrey Zokufa, believes the policy is “about creating a social solidarity principle.” Should that be his concern – or should he be batting for the medical schemes his organisation represents? Among the proposals, medical schemes will not be able to offer any benefits supplied by state facilities, medical schemes’ members will have to use state (or state approved) facilities and – wait for it – pay out of pocket for anything government deems as private treatment.

What future will private medical schemes have? Will they simply be administrative nets to assist in channelling member funds to an NHI super-fund? This scenario is administratively inefficient. Why pay to a medical scheme if practically every aspect of your healthcare will be funded from the NHI pool. We find the BHF suggestion that the NHI will provide opportunities for medical schemes to expand their reach as a trifle absurd. Medical schemes’ membership has been stagnant for many years – and if the NHI proposal goes ahead the only likely candidate for a medical scheme will be truly wealthy, someone already in the net!

Speaking at the Hospital Association of SA (Hasa) conference in Durban (held in June 2009) health economist Alex van den Heever dismissed the NHI proposal as a “completely unworkable, unaffordable solution that won’t improve health services despite massive increases in expenditure.” But government says it will proceed with an accelerated NHI implementation regardless of these concerns. At the same conference, Dr Molefi Sefularo, deputy minister of health, said the department’s NHI plans would be subject to scrutiny. “We have noted the concerns of the private sector about the prolonged silence [from the department of health] on NHI and lack of certainty about what is contained in our plans,” he said. “It will not be sprung on you by surprise. There will be ample opportunity for debate and contribution.”

Is this propaganda or sensation-seeking?

As NHI looms one has to question the timing of this week’s Sunday Times medical schemes exposé. The stories are not new. Complaints about increasing medical costs, shrinking medical schemes benefits and insufficient day-to-day medical expense funds have been on the rise for some time now. And that leads to the question: Is the Sunday Times drumming up support for government’s inevitable healthcare intervention?

Editor’s thoughts:
The implementation of South Africa’s National Health Insurance fund is going to radically alter the healthcare industry. There are many questions that have to be answered. What role will private hospitals play – how will medical schemes be accommodated – and how will the already overburdened system accommodate millions of new healthcare beneficiaries? Do you believe an NHI implementation will improve the standard (and affordability) of healthcare for all South Africans? Add your comments below, or send them to gareth@fanews.co.za

Comments

Added by phy501, 01 Sep 2009
the thing that bothers me most, what is going to happen to us as providers? i'm in private practice and so are most of my colleagues. is the nhi going to do nhrpl rates of current? or are they going to drop the cost to something ridiculous? we as professionals studied long and hard to get where we are - and yes i agree everyone is entitled to affordable healthcare, but its your constitutional right to have a medical aid. look at the uk - the nhs is bankrupt, and most uk citizens have medical insurance. what about the us - there it is compulsary to have medical insurance. to be honest - if the government wants to lose all their providers - then implement the nhi - we will be on the first plane out of here - and i love sa, but if i cant make a living in my profession ill have no other choice.
Report Abuse
Added by QvR, 18 Aug 2009
It is about time a spotlight is shone on private medical aid schemes and their shortcomings. Some in the ANC seem to think that private medical schemes are the panacea for members of these schemes, while the rest of the population has to make do with poor facilities, treatment and healthcare quality. This is what the Sunday Times article does - members of private medical aid schemes are battling as well! The whole system needs a revamp, and NHI is a starting point to get the debate going. Let's hope sanity prevails and we do not all end up in an expensive, overburbened, corrupt and incompetent national scheme.
Report Abuse
Added by Eugene Slabbert, 18 Aug 2009
As a M/Aid member I am extremely concerned about proposed developments. I suspect that GP's and specialists etc will emigrate in droves. What has happened with Eskom will be repeated here, 8 million members will have to carry another 32 million "passengers". It is just not possible and unfortunately it will take an eternity before powers that be will realize that this is an impossible dream. Not that it will make any difference I nevertheless suggest a major effort be made to get each and every one of the 8 milion medical aid members to sign a petition rejecting this proposal.
Report Abuse
Added by SF Nzama, 18 Aug 2009
Sometimes change is good, especially when it comes to our not-so-inclusive healthcare system. Why do we have to jump to conclusions that NHI will not work, will be inefficient and that medical schemes will be obsolete. I find it strange that even the Editor seems to misunderstand Mr Zokufa' s point (or BHF's view for that matter) with regards to increase in schemes beneficiaries with the introduction of NHI. We should be asking more about the role of schemes in NHI and how NHI will have to improve both benefits and services for all South African (which include ALL current scheme beneficiaries!). Why do we have to be always negative and looking for failure in our government initiative? Maybe the government has been 'inefficient' in some (or even many) of its businesses, but I believe the change in the healthcare industry is inevitable, be it South Africa or US. Our current not-so-inclusive system can not be maintained any longer.
Report Abuse
Added by Rikus, 17 Aug 2009
I think the easiest way to put this in perspective is to ask the question of how may South Africans are contributing towards tax? Pretty sure that most of these tax paying citizens are also those prepared to pay the premium for private health care. Therefore how may wil support how many? If out tax money is not sufficient at this moment to run the infastrucure properly, what will be the differance later when NHI gets implemented? Only that tax payers will again "earn" less cash for less benefits! Why must the few provide for the many again. This is not like driving my car through potholes, these are services that will either save the life of my child or not!
Report Abuse
Added by MMG, 17 Aug 2009
NHI can never work in South Africa. We will loose all our good doctors & specialists. We have had doctors & hospital staff striking for days due to poor salaries & annual increases, how will our government cope with paying all doctors & specialists under NHI? It will be very unfair on doctors!
Report Abuse
Added by John, 17 Aug 2009
The NHI is totally impractical and will never work. Is Government going to compensate Health brokers for loss of income if everyone joins NHI? There is place for a better National Health facility, but not at the expense of general public who has already taken out their own private medical aid.
Report Abuse
Added by Margaret, 17 Aug 2009
Given the shocking state of the Government hospitals, I feel the implementation of NHI will drag down the standards of private hospitals, demorolise Doctors and certainly make a lot more people think of emigrating. The people need to question just what will we get access to, access to all, but access to what. Because of the cost involved I think the Govt will just focus on the access to all and to hell with the quality, a short term political fix with terrible long term consequenses. I think NHI will cause a long slow decline in private hospital standards. What a pity the focus is not on building up the standards of the Govt Hospitals. Hospitals need to be run on a business model, with managers that know how to manage.
Report Abuse
Added by CYNICAL SIMON, 17 Aug 2009
I have been under the impression that Governments main task is to Govern.Now that may be only my own mistaken assumption because Government is clearly making a hash of Governing.The Provincial structures are disfunctional,crime is beyond control,[Policing is a joke,the Department of justice have become the epitomy of nepotism and favouratism,Government departments like Home Affairs have become roosts of iniquity ,Government Hospitals have become places where people go once they have uncontrollable death wishes .Therefor since the death penalty had been abolished and Government cant openly re-introduce it perhaps they think they can bring it back COVERTLY and call it NHI.
Report Abuse
Added by Mike T, 17 Aug 2009
How on earth do the Government believe that they are capable of running a NHI scheme, when they can't maintaine the existing "government" health facilities like hospitals and clinics in a medically clean and sterile way, let alone the absence of essential equipment and simple things like bedding? When governments think that they can do things better than the professionals who have been doing the work well for years, that is when disaster is looming - look at the country to the north of us - the health services there are now almost NON EXISTANT - thanks to a man who wanted to CONTROL EVERYTHING. The United Kingdoms NHI scheme still has huge failings - people have to wait for years to get proceedures done that we in South Africa can have done at will by the most professional health care providers - and this is as a result of our PRIVATE health care system. Long may it last!!!
Report Abuse
Added by Hein Eksteen, 17 Aug 2009
There is close to seven million people on medical aid in South Africa , whereby half these people are on a very basic plan. Lets assume that the most people that can afford a medical aid arealready on a medical plan. If these contributions must be channelled to provide for 50 million people , and lets assume at this stage that goverment find it diffucult to adminster the existing fasilities . My thoughts would be that they will provide a very basic sevice. This is the greatest challenge to any goverment world wide, and the only country where this is working is Kuwait . Kuwait is cash rich and uses foreighn doctors . We are not in their position .If we conduct a duo-dilligence study for the feasibility of the NHI . Oh no, lets rather leave that route. If goverments most successful project to date is the cutting down of alien plants species , and I know there is also problems , I think it will be better for goverment to first provide the infrastucture and then design the NHI and then to implement it. I personally arent ready to work through a goverment department if I want to see a doctor,and after being through the whole process only to be told that there are no doctors. The seven million that contribute will then contribute for 50 million. Not difficult to to make a few calculations .
Report Abuse
Added by George Thom, 17 Aug 2009
A scheme such as NHI can only succeed if we have a thriving workforce and NOT an unacceptable high unemployment figure as we have in SA. Secondly, even with a high employment figure countries like the USA and UK are struggling to deliver the medical care to their citizens. Are we going to show the USA & UK how it should be done? Ha, I doubt. Medical care based on the NHI is the end for all SA's people.
Report Abuse
Added by Bertie, 17 Aug 2009
I attended the "Big Debate" some weeks back and such as with National "Pension Scheme" glory hunters are chasing after scraps/"stars" in our political minefield. I walked out there understanding one thing only and that is that the golden goose would be forced to abort the last half formed egg ..... Government simply cannot appreciate the enormity of their challenge - to themself, private health care system and the public at large. Fact is we all know that the cause of the headacke is not necessarily to be found in the head!!!!!
Report Abuse
Added by Tanya, 17 Aug 2009
This is just my perspective and my immediate concern. My husband and I planned to start with our family in 2-4 years time, but now I think that I should get pregnant now, while I can still pick my own doctor that I am comfortable with, with all the relevant qualifications and while I know that my medical aid will pay for the expenses.
Report Abuse
Added by Nickey, 17 Aug 2009
highlighted at the recent Metropolitan Health Engage Forum, something said as early as 1984... “Friend, you cannot legislate the poor into freedom by legislating the wealthy out of freedom.  And what one person receives without working for, another person must work for without receiving. The government can’t give to anybody anything that the government does not first take from somebody. And when half of the people get the idea they don’t have to work because the other half’s going to take care of them, and when the other half get the idea it does no good to work because somebody’s going to get what I work for. That, dear friend, is about the end of any nation.” Read and posted in the Congressional Record by Congressman Steve King from the state of Iowa on January 14, 2009. If only Government will take notice...
Report Abuse
Added by Dee, 17 Aug 2009
Surely every taxpaying South African citizen has a constitutional right to elect to PAY for medical aid and to receive the benefits thereof. The ordinary hard-working individuals that pay taxes religiously and contribute to the economy of the country are expected to give, and give, and sacrifice and give - I'm sure you get my point. I have been working since the age of 18 and I feel entitled to have the medical care that I can afford. What do they think will happen when an already inept system is bombarded with millions more? Why should I now have to give up seeing my regular doctor and dentist just to satisfy the masses. I am not being unsympathetic to others, having my own family members who cannot afford medical aid but why make one obsolete for the sake of implementing another? When it comes to other issues, they are first in line to shout about 'RIGHTS'. So now what happens to every person's RIGHT TO CHOOSE?! I am in total agreement with Nickey's comments in that it stands to reason that those who will be benefiting but not contributing will be the bone of contention for those thare are contributing and have had to sacrifice ... a recipe for unequivical disaster, in my opinion.
Report Abuse
Added by Leon van der Walt, 17 Aug 2009
It is the Governments task to do the upkeep of the national roads. How much of the funds intended for the roads actually get spend on the roads? The national health will end up in the same way -I cannot see why it would be different, Almost all of the money ending up in the pockets of the officials and very little available to the medical fraternity. The Government must first prove that they can actually do what they set out to do.
Report Abuse
Added by JR, 17 Aug 2009
Point overlooked is that govenment set out to destroy medical aids years ago - forcing a medical aid cover people who only join once they already have medical problems - like aids for example, is like forcing a Short term insurer to give fire cover on a house,with a thatched roof,in a lightning prone area,with no fire fighting facilities in the area, which is already on fire AND not being allowed to even charge an extra premium .A medical aid was never supposed to be a CHARITY . The medical aids are not the criminals-the government are.
Report Abuse
Added by jim, 17 Aug 2009
It is interesting to see that the Americans are in the same sort of debate, with Obama speaking gobbildy gook and apparently digging a hole for himself and they are only trying to get 40 or 50 million onto some sort of cover out of a population of 350 million! Is Obama going to pull the plug on grandma? The exisitng government schemes are nearly bankrupt and they expect the new schem to bankrupt the country if they are not already bankrupt. Are we trying to put 35 million on from a population of 45 million? I wonder what fraud rate they will build into the cost of the scheme? Surely we need a class action suit to the constitutional court to protect our right to protect ourselves and families as we see fit? Can we start such a fund to protect our rights?
Report Abuse
Added by HZF, 17 Aug 2009
We have learned over the years that government just follows its own head whenever they plan to do something new. Yes, they do follow "due process" by allowing inputs and comment from the industry, but in the end they hardly ever take note of what the industry experts had to contribute. This was the case with all the drastic changes to the Medical Schemes Act in the late nineties and now we see the so-called "unintended consequences" of their stubbornness in the affordability crisis with medical scheme premiums. The same is going to happen with this NHI as well. Just this time around, the unintended consequences will have disastrous results for our country's whole population. (I pray to God that I may be wrong- but I am afraid I will be praying in vain.)
Report Abuse

Comment on this post

Name*
Email Address*
Comment
Security Check *
   
Quick Polls

QUESTION

South Africa went to Davos to pitch itself as an investor-friendly destination, then signed an Expropriation Act. What message does this send to global investors?

ANSWER

Invest at your peril
SA is open for business
Two steps forward, one land grab back
Welcome to Hotel California
fanews magazine
FAnews February 2025 Get the latest issue of FAnews

This month's headlines

Unseen risks: insuring against the impact of AI gone wrong
Machine vs human: finding the balance
Is embedded insurance the end of traditional broker channels?
Client aspirations take centre stage as advisers rethink retirement planning
Maximise TFSA contributions before year-end
Subscribe now