HASA reacts to PMBs review

HASA reacts to PMBs review

By Terri Chowles, 7 December 2016, ehealthnews.co.za.

HASA has welcomed the review of the Prescribed Minimum Benefits (PMBs) while cautioning the CMS to not unduly reduce patient protections and benefits.

The Hospital Association of South Africa (HASA) has welcomed the review of Prescribed Minimum Benefits (PMBs) by the Council for Medical Schemes (CMS) while cautioning the council to not unduly reduce patient protections and benefits.PMBs include 26 chronic conditions and 270 diseases that have to be covered by medical aids no matter the cost. While PMBs are intended to protect the patient, according to a Competition Commission’s independent inquiry into health costs PBMs are responsible for driving up cost for the consumer.

The CMS has therefore embarked on a review of PMBs to ensure that the basic benefits are “financially sustainable” and “viable”. This will entail a comprehensive review of the medical scheme legislation and re-evaluation of which diseases are covered as a basic package of care, as well as if some diseases need to be removed or added.

“We agree that PMBs have contributed to the increased cost of medical scheme contributions. This has been exacerbated by anti-selection and the absence of a risk adjustment mechanism in the medical scheme environment,” said HASA CEO, Dr Dumisani Bomela.

“We also acknowledge that there are uncertainties and confusion among consumers with respect to PMBs. Nevertheless, PMBs are an important insurance mechanism for protecting medical scheme members against catastrophic healthcare expenses. PMBs should thus be retained as far as possible and supplemented with essential primary care benefits,” continued Dr Bomela.

HASA has also urged the CMS to re-consider other regulatory initiatives that have been raised by experts that could similarly reduce the costs of medical scheme cover.

“These include a review of the medical scheme regulatory reserve requirement; the implementation of a risk equalisation fund; the implementation of a low-cost benefit option; and the requirement for compulsory medical scheme membership among employed persons. Taken together, these reforms could provide significant relief for consumers and medical schemes,” concluded Dr Bomela.


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