BHF360° | DECEMBER 2020
H E A LT H S Y S T E M S S T R E N G T H E NING
Implementation of the Health Market Inquiry recommendations
WHERE DO WE START? By Mark Bayley MD: ADMINISTRATION, UNIVERSAL HEALTHCARE
T
he Health Market Inquiry (HMI), which completed its findings on 30 September 2019, found that the private health market is characterised by highly concentrated funders and facilities markets, disempowered and uninformed consumers, a general absence of value-based purchasing, and practitioners who are subject to little regulation and failures of accountability at many levels. It also concluded that the market is typified by high and increasing expenditure, excessive utilisation of health resources, and that no effective measures were in place to improve health outcomes. The updated HMI stakeholder communication of 11 September 2020 outlined certain recommendations that could pre-empt the introduction of national health insurance (NHI) by the state, enabling an environment where specific interventions would lead to greater competition and efficiency,
The private healthcare sector needs to transform as the current model is unsustainable. But the question remains as to where medical schemes, as custodians of member funds, can proactively start within the existing legislative framework. shifting towards a pro-competitive environment. The private healthcare sector needs to transform as the current model is unsustainable. With the Minister of Health reaffirming the state’s commitment to implementing NHI, medical schemes and administrators have a window of opportunity to play a facilitative role in addressing some of the HMI concerns to ensure a meaningful role for healthcare funders in the future. As medical schemes rely on the Department of Health (DoH) and Council for Medical Schemes (CMS) to initiate the necessary structures and enabling legislation to implement
the HMI recommendations, there are numerous factors outside the influence and control of schemes. The question remains, however, as to where medical schemes, as custodians of member funds, can proactively start within the existing legislative framework.
PLAY AN ACTIVE ROLE Medical schemes can play a more active role in influencing and providing constructive input into the unfolding legislative environment. They can also collaborate with the DoH and other stakeholders in a spirit of fairness, cooperation and constructive engagement to align the business of health funding with the principles of universal health coverage.
B O A R D O F H E A LT H C A R E F U N D E R S
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