Response to the review of the Prescribed Minimum Benefits (PMB’s) by the Council for Medical Schemes

Response to the review of the Prescribed Minimum Benefits (PMB’s) by the Council for Medical Schemes

7 December 2016, By Dr Dumisani Bomela, HASA CEO.

“While the Hospital Association of South Africa welcomes the review of the Prescribed Minimum Benefits (PMB’s) by the Council for Medical Schemes as reported in The Times today, we caution that the review should seek wherever possible to not unduly reduce patient protections and benefits. In addition, we urge the Council to embark on a more comprehensive review of medical scheme legislation with the aim of reducing the cost of medical scheme membership and enhancing its sustainability.

We agree that PMB’s 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. We also acknowledge that there are uncertainties and confusion among consumers with respect to PMB’s. Nevertheless PMB’s are an important insurance mechanism for protecting medical scheme members against catastrophic healthcare expenses. PMB’s should thus be retained as far as possible and supplemented with essential primary care benefits.

Even as the PMBs are reviewed, we would urge the Council to re-consider other regulatory initiatives that have been raised by many experts and 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.”

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