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Medical schemes cast doubt on NHI

Medical schemes in SA doubt the success of government’s ambitious National Health Insurance (NHI) and believe the provision of healthcare in the country is deteriorating‚ a recent survey reveals.

The survey‚ titled‚ Strategic and Emerging Issues in the Medical Scheme Industry‚ by professional services firm PwC‚ shows the schemes believe the NHI alone is not the solution to SA’s healthcare problems.

Respondents to the survey believed working conditions first needed to be improved and a total overhaul of basic resources should be implemented before NHI.

The survey focused on strategic and emerging issues in the South African medical scheme industry.

The survey was aimed at raising awareness of medical schemes views on emerging trends and issues in the industry‚ understanding the strategic thinking of principal officers in the sector‚ and providing insight into how the industry may evolve over the next three years.

Principal of the survey‚ Ilse French‚ PwC’s medical schemes leader for southern Africa‚ said: “The medical scheme industry in SA faces unique challenges and it is important that it evaluates and adapt to the needs of the emerging market.”

The survey said only a quarter of the participants agreed that the introduction of the NHI system would change the current state of healthcare if it was implemented in accordance with the focus contained in the NHI Green Paper.

According to the survey‚ more than half of medical schemes were of the opinion that the recently announced investigation by SA’s Competition Commission into healthcare costs could be useful‚ and 38% believed such an investigation was long overdue.

The majority of participants (95%) were of the view that prescribed minimum benefits (PMBs) paid in full resulted in excessive benefits being paid by medical schemes to the detriment of members. Participants believed that because there was no control over what tariff a provider could charge‚ members’ benefits may be at risk due to possible unwarranted‚ uncontrolled expenditure.

Commenting on the survey‚ Tom Winterboer‚ financial services leader for southern Africa and Africa at PwC‚ said: “This is just one of several findings surrounding the medical aid industry contained in PwC’s first edition of the Strategic and Emerging Issues in the Medical Scheme Industry survey‚ which was carried out among principal officers of 20 schemes registered in SA and one from Namibia‚ covering 53% of the South African industry based on 2010 average principal members.”

The survey also reveals the importance of information and communications technology in health management‚ saying: “Schemes cited managing data and data quality as the major technology weaknesses within the industry. Almost half of the schemes have considered the role of e-health in reducing costs and improving accessibility.” - I-Net Bridge

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