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South Africa: More Medical Scheme Regulations on the Way
Source: Published in: Legalbrief
Source Date: Friday, October 25, 2013
Focus: Institution and HR Management
Country: South Africa
Created: Oct 25, 2013

Speaking at the 14th Annual Conference of the Board of Healthcare Funders, the Deputy Minister said that there are 'a number of products on the market' creating the impression that they are 'doing the business' of medical insurance schemes when, in fact, they offer short-term insurance. 'We need to regulate these products either as medical insurance schemes or short term insurance products,' she said.

According to Ramokgopa, many medical scheme members experience difficulties in understanding the products they have purchased, despite being relatively well educated. In her view, this points to the need for a review of the overall structure of medical schemes and the 'plethora of benefits' on offer with the aim of developing a 'more patient-oriented' medical insurance industry. She referred in particular to prescribed minimum benefits. In the Deputy Minister's view, a common understanding is needed across medical schemes, health care providers and consumers of the benefits provided by different options.

The Deputy Minister also expressed concern about the extent to which inadequate technical knowledge on the part of many medical scheme members stands in the way of constructive engagement with scheme administrators about rejected claims. 'The Council for Medical Schemes' role in adjudicating ... member complaints is unknown to many scheme members,' Ramokgopa said, appealing to scheme administrators to inform their membership of the appeal options available. In addition, she urged the industry and the Council for Medical Schemes to work together in devising methods for resolving disputes that are less time-consuming and more cost effective.

On private sector health care as a whole, the Deputy Minister blamed the 'inexorable commercialism' of their 'hospicentric approach' for undermining the provision of health care services as a public good. She described the private hospital sector - with its 'strong for-profit focus' - as 'one of the most lucrative investment options in the country, even during periods of economic downturn'. According to Ramokgopa, 'the status quo cannot continue'. Government 'must take decisive steps' to redress the fragmented, two-tier, public-private health care dichotomy in order to protect the right of all South Africans to health promotion and care services, regardless of who provides them. She called for a shared vision across both public and private sectors for a transformed health care system characterised by 'social solidarity, risk pooling, efficiency, effectiveness and affordability'.
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