BHF360° | DECEMBER 2020
HE ALTH SYS T E MS S T RE N GT H E NI N G
LOW-COST BENEFIT OPTIONS – key to broadening access to healthcare services By Dr Katlego Mothudi
The contentious matter of low-cost benefit options for medical schemes has been on the table for a number of years, without much demonstrable progress.
MANAGING DIRECTOR, BHF
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ccess to essential healthcare services has remained elusive for many South Africans. About 16% of the country’s population is covered by medical schemes, while the remainder of the population depends on an overburdened public sector. This figure does not account for a growing number of people who opt to use private doctors for their primary care needs. It does, however, demonstrate the fact that a huge part of the population still relies heavily on public healthcare. To alleviate strain on the public healthcare system, which has further been exacerbated by the COVID-19 outbreak, the Board of Healthcare Funders (BHF) is of the opinion that the granting of exceptions to implement low-cost benefit options (LCBOs) to medical schemes will help to slash their membership subscriptions by large tranches. This, in turn, will broaden access to private medical care and consequently reduce the out-of-
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pocket payments made by the uncovered population for their primary care visits. LCBOs were introduced by medical aid schemes to make their membership more accessible to as many people as possible. An LCBO benefit package largely covers primary care services, such as patient treatment for common ailments including colds and flu, minor injuries, high blood pressure, high cholesterol, asthma, diabetes, vaccinations and birth control; but excludes hospitalisation. The Council for Medical Schemes (CMS) reports that most schemes spend more than 50% on hospital admissions and hospitalisationrelated costs. The law currently requires that all medical schemes must include a benefit package that includes hospitalisation, which increases medical aid premiums and makes them out of reach for many people who may not necessarily require hospitalisation; yet in contrast, everyone will require primary healthcare services at one time or another. Medical schemes, however, are required by law to set member contributions on
