There Is Much We Can Do Now To Help Healthcare Consumers

There Is Much We Can Do Now To Help Healthcare Consumers

While the debates about the National Health Insurance Bill and the missing pen needed to sign it continue, what immediate actions could assist healthcare consumers in the short term?

First and foremost, the urgency of the Prescribed Minimum Benefits (PMBs) review process cannot be overstated. These provisions, overseen by the Council for Medical Schemes, are crucial for patients facing potential catastrophic health events. Despite being mandated for review every two years, they have not been revisited since their implementation over a decade ago. This is a critical consumer protection measure, and its review is a pressing need to ensure the proper safeguarding of consumers in times of trauma.

Next, consider the potential benefits of policy reforms in the medical scheme universe. If implemented, these reforms could significantly alleviate the financial burden on consumers, making private healthcare more accessible in the near term. They encompass introducing risk equalisation, reforming rules on medical scheme reserves, and even mandating scheme membership for the formally employed. The combination of these measures presents a compelling case for care while effectively managing scheme members’ insurance costs.

These reforms to the medical schemes’ universe are natural conclusions to processes that began with the commencement of the Medical Schemes Act of 1998 but were never completed, leaving schemes exposed to risk and high premium increases. For example, many schemes now have ageing membership profiles and diminished numbers of young members to subsidise older members as expected in the social solidarity environment in which the schemes operate.

The Healthcare Market Inquiry (HMI) called for standardised Low-Cost Benefit Options (LCBO) underwritten by medical schemes. The HMI call is to ensure as many South Africans as possible can enjoy quality healthcare. After a protracted period, the Council for Medical Schemes only recently gave its related recommendations to the Minister for consideration. This ought to be urgently attended to.

Lastly, the detrimental effects of corruption in the healthcare system cannot be ignored. This pervasive issue is not only a moral concern but also a significant financial burden on consumers. A concerted effort to combat corruption could potentially free up substantial financial resources, which could then be redirected to reduce the financial strain on consumers.

We are already struggling to address numerous challenges, like expanding medical and nurse training facilities, refurbishing healthcare facilities, attending to the working conditions of skilled medical personnel, and retaining strong management in healthcare.  Solutions to these issues constitute a firmer footing for universal healthcare.

However, should the Government persist in implementing National Health Insurance, as the Minister of Finance pointed out in his Budget Speech, we are in for a long wait before we effect change in the health system. While we work towards a sustainable, accessible and responsive system, there are things we should do, without delay.

One Response

  1. PLEASE PMB benefits need revision especially regarding psychiatric benefits. 21 inpatient days are insufficient for someone with severe depression – never mind that I pay ALL my consultations with psychologists and psychiatrists out of pocket. It’s a huge burden on myself and family.

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