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CMS says amendment to PMB regulation 8 aims to assist members and schemes

30 July 2015

The Council for Medical Schemes (CMS), regulator of the medical schemes industry, commented today on the proposed amendments to Regulation 8 - pertaining to prescribed minimum benefits (PMBs) made in terms of the Medical Schemes Act, 131 of 1998 (the Act).

Board of Healthcare Funders committed to eradicating fraud in the schemes industry

29 July 2015

Healthcare provider fraud, along with waste and abuse, has a dramatic impact on the already constrained resources of the medical schemes industry. It is estimated that at least 7% of medical aid claims are fraudulent and the figure might be as high as 15%. “Approximately R130 billion/year is spent in the private healthcare sector in South Africa. If 10% of claims are fraudulent, it means fraud costs us R13 billion/year,” Dr Hleli Nhlapo told delegates at the 16th annual Board of Healthcare Funders’ (BHF) conference. Dr Nhlapo is the deputy chairman of BHF’s Healthcare Forensic Management Unit (HFMU). “Every scheme is affected,” he said. He called on the industry to work together to combat this scourge that is detrimental to the funding industry’s ability to ensure the best possible care for the patients it serves.

Accountability is the cornerstone of sustainable healthcare

28 July 2015

The key goal of the 16th annual Board of Healthcare Funders’ conference is to come up with a roadmap to a sustainable future healthcare system. To this end, the conference is hosting various parallel sessions to debate the key issues and barriers to such a system with a view to coming up with concrete practical proposals that will take us from the system we currently have – fragmented, unsustainable, high-cost, stagnant in terms of medical scheme membership and of variable quality – to one that is sustainable, integrated and, above all, patient centric. This requires accountability throughout the system. “Healthcare is one of the key components of prosperity so an improved healthcare system is imperative to creating a prosperous society and country,” Dr Tebogo Phaleng, Executive Director at Coalesce, an independent health strategy advisory agency, told delegates. “South Africa is currently ineffective in achieving equitable access to health and protecting its citizens from the financial consequences of ill health. This cannot be allowed to continue. If it does, our children will certainly not have access to the healthcare we do at the moment.” The conference discussions mark the fourth phase in the journey towards this road map, further to a pre-conference survey, a gap analysis and a strategic think tank, which identified those areas of the current system that need re-evaluation. “The debates are intended to be collaborative, exploratory and iterative and will take place in a safe space for collaboration.”

The quality of healthcare – is it enough?

28 July 2015

Reviewing the findings of the 2015 Health Quality Assessment 2015, Dr Johann van Zyl of Towers Watson’s short answer to the question was ‘no’. This is despite some encouraging trends in certain areas and an increasingly robust data set accumulated over five years, embracing approximately 77% of covered beneficiaries across 18 schemes, nine administrators and 168 health quality indicators. “So much more is still possible,” he told delegates at the 16th annual conference of the Board of Healthcare Funders. “Whether the improvements in quality of care that we have observed translate into true value, given the dramatic increases in both contributions and claims, is also open to debate,” he said.

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The strongest deterrent against FSP compliance missteps is or should be:

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A criminal conviction Debarment Fine or penalty Any of the above can work

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