Clumsy law-making on healthcare and the failure to correct it have resulted in medical schemes carrying an almost unlimited liability for prescribed minimum benefits (PMBs), while nearly 10 million people are being denied low-cost benefits for primary healthcare.
Unregulated consultant tariffs and the reluctance of the Council for Medical Schemes (CMS) the governments chief proxy to approve low-cost benefits schemes are driving medical inflation and sending medical aid premiums soaring, according to Rajesh Patel, the head of health systems strengthening at the Board of Healthcare Funders (BFH), and Charlton Murove, the head of research.
They said the National Health Insurance (NHI), which looms on a 10- to 20-year time horizon, would effectively put paid to medical schemes. The government says the NHI aims to enable equitable access to quality healthcare.
The BHF is the representative organisation for the majority of medical schemes in South Africa, Namibia, Zimbabwe, Botswana and Lesotho.
Patel and Murove said healthcare in South Africa is unnecessarily complex, with dismal regulatory oversight in which patients suffer financial hardship while struggling to negotiate a healthcare funding jungle.
Against this backdrop, industry experts have welcomed a recent web-based innovation, MedicalAid.com m, which provides accurate medical aid comparisons through a sliding premium affordability button while listing benefits.
One of the biggest oversight challenges is PMBs [prescribed minimum benefits
