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BusinessDay www.businessday.co.za Thursday 20 October 2022
INSIGHTS
MEDICAL COVER OPTIONS FOR 2023 Sponsored content
Navigating the medical cover minefield
Health is your greatest asset: plan accordingly
Members need to educate themselves regarding their •rights and entitlements, writes Lynette Dicey
C
hoosing the most appropriate type of healthcare cover and figuring out the differences between medical aid schemes, gap cover and health insurance can be confusing. Medical schemes are notfor-profit entities governed by boards of trustees that operate under the Medical Schemes Act to provide funding for healthcare goods and services in return for a monthly contribution. Barry Childs, joint CEO of Insight Actuaries & Consultants, an actuarial and analytics firm practicing in the healthcare and life insurance fields, explains that medical schemes are obliged to accept any applicant, are required to provide a minimum set of benefits and can only differentiate the contribution based on income, benefit option and type of beneficiary such as the main member or dependant type. Some medical schemes, he adds, are restricted medical schemes, meaning that they are specific to an employer or an industry or association. Polmed, for example, is a scheme for the SA Police Service, while Bankmed is a medical scheme specifically designated for the banking industry. Open medical schemes, on the other hand, are open to anyone to join. However, depending on your history of medical scheme membership and pre-existing health conditions, some underwriting conditions and/or contribution penalties can be applied when joining a medical scheme. Gap cover insurance was introduced in the early 2000s in response to the growing gap between what specialists charged for their services and what medical schemes paid for specialist services, says Childs. “This gap has continued to grow, and gap cover products have become more prominent. Over time, other benefits have been added to gap cover products such as a benefit to
Barry Childs … healthcare products are complex. fund co-payments and other benefits medical schemes may not pay for in full.” Gap cover products are for-profit insurance products governed by the Short Term Insurance Act. “There are fewer requirements for gap cover insurers in terms of who they must accept on the cover, how much they can charge and the level of benefits they must provide,” explains Childs. Health insurance, on the other hand, is a broad term that includes gap cover and, more recently, primary health insurance cover. Primary health insurance products, reveals Childs, are for-profit insurers that mainly cover primary care services such as visits to a GP, basic
medication, pathology and radiology cover. They don’t usually include hospital cover or cover for serious illness such as cancer. Due to the fact that they don’t have to offer the same minimum benefits, they offer cover at a lower cost than medical schemes in return for covering less benefits. “The benefits included in primary health insurance products have been the subject of intense industry discussion since 2006. Recently the market for these products has grown as well as the need to have them formally regulated. Industry stakeholders and the regulator are in the process of formalising their place in healthcare funding in SA.” These different products all provide some degree of healthcare benefits. “In a nutshell, those who can afford medical scheme cover should join a medical scheme as early as they can as this provides the best access to private healthcare treatment, especially private hospital treatment,” says Childs. “Joining at a young age and maintaining your membership can help avoid late joiner premium penalties and underwriting. Depending on the benefits of your particular medical scheme, you might also want to buy gap cover if you can afford it on top of your
medical scheme contribution and are worried about shortfalls given the difference between what your medical scheme will pay and what specialists might charge above the so-called medical scheme rate.” He suggests primary care insurance for those who can’t afford medical scheme cover
MOST SCHEMES ALLOW YOU TO CHANGE THE BENEFIT OPTION ONCE A YEAR — USUALLY IN JANUARY — IF YOU DECIDE YOU NEED MORE COVER but still want funding for primary care benefits such as GP visits, some limited medicine and basic dentistry from private healthcare providers. However, he warns that health insurance does not
replace medical aid. “It’s important to understand the benefit brochure of whatever you buy as, unfortunately, healthcare products are complex,” he cautions. “When choosing what cover to buy, balance your expected healthcare needs with affordability. Most medical schemes allow you to change the benefit option once a year — usually in January — if you decide you need more cover. When you apply to a scheme for membership, be prepared to answer some complex questions, including what cover you have previously had, your reason for changing schemes and information on medical conditions, which can affect whether you get any underwriting or contribution penalties imposed for only joining later in life.” Conceding that navigating the fine print can be complicated, he says members need to educate themselves regarding their rights and entitlements. “Benefits can change yearly so it’s difficult knowing what you are covered for and what you are not covered for, particularly for unanticipated health events such as surgery. It’s a good idea to stay abreast of what benefits are offered by your scheme.” He suggests working through a broker for advice. “It doesn’t cost any more to use a broker as their commission is built into the premium. A good broker is likely to be more familiar with any changes and the issues that tend to come up regularly and should help navigate those changes for you. They can also deal with service complaints and benefit queries.”
For many people, medical scheme membership is a grudge monthly payment. Although some young people choose to delay becoming a member of a medical aid, Alan Fritz, acting principal officer of Medshield Medical Scheme, points out that the Medical Schemes Act allows schemes to impose waiting periods and late-joiner penalties on those who only join a scheme later in life. “Your health is your greatest asset, so it requires careful financial consideration and planning,” advises Fritz. “Choosing the right plan can be pretty complex. You need to consider what type of plan you can afford and your current health status, including your age and other risk factors.” Most medical schemes, including Medshield, offer various plans to suit different lifestyles and age groups with cover that caters for the individual from childhood to adulthood and well into old age. “We partner with capable and quality healthcare providers and negotiate with those partners to provide value for money services to our members. With more than 50 years’ experience and a solid financial and claims paying ability track record, Medshield members are assured that their health is in good hands for the long term.” Medshield members have access to a loyalty programme through Elevate and Just Rewards which provides access to new technology that records and stores their lifestyle data in one place and rewards them for healthy behaviour. It also links to smartphones and wearable
Alan Fritz … unlimited in-hospital cover at the very least. devices to measure and reward them for their physical activity. Rewards include grocery savings, legal benefits, dining out, movie, retail and gym membership benefits. Fritz reveals that Medshield has a plan for every stage of life. MediCurve is an affordable digital plan aimed at young, healthy, tech-savvy, first-time medical aid buyers. It offers a bouquet of in-hospital and out-of-hospital benefits with free, unlimited virtual family practitioner consultations through the Medshield SmartCare benefits. MediSwift is a cost-effective, value-based hospital plan that provides amateur sportsmen and women with additional physiotherapy and biokinetics benefits for both in-hospital and out-of-hospital. The MediPhila option provides protection from unforeseen medical costs through unlimited hospital cover for PMB conditions, per
beneficiary limits for non-PMB in-hospital treatments and an out-of-hospital benefit limit for specific services. For young families, MediValue is a good option, providing for unlimited hospital and partial day-to-day cover. This option has both a Prime and Compact category. The benefits are the same in both, but for a smaller contribution, the Compact category requires the compulsory use of Medshield Provider Networks. MediSaver is aimed at independent individuals who want to manage their own out-of-hospital healthcare expenses through a personal savings account with unlimited hospital cover. MediPlus is aimed at middle to upper-income earners, offering unlimited in-hospital cover and a generous day-today limit. This option has both a Prime and Compact category. The benefits of both are the same, but the latter requires the compulsory use of Medshield Provider Networks. MediBonus is a good choice for corporate employees and individuals who need comprehensive unlimited inhospital cover and extensive day-to-day benefits while PremiumPlus provides the most comprehensive cover with freedom of choice including no network restrictions, 200% cover for certain in-hospital procedures and a personal savings account. At the very least, everyone should have unlimited inhospital cover in case of major medical emergencies, advises Fritz, adding that MediCore is a hospital plan for those who require unlimited hospital cover, with full PMB cover.
Gap cover can reduce co-payments, shortfalls Even with medical cover there are often significant copayments, particularly on more affordable plan options where there are often shortfalls, particularly when it comes to specialist treatment in hospital. Tony Singleton, CEO at Turnberry Management Risk Options, points out that funding these shortfalls can place a strain on already stretched budgets. “One of the most affordable ways to ensure that quality healthcare can be funded is to augment medical aid cover with an appropriate gap cover policy,” he says. “Often, the more cost-effective medical scheme options have limited cover for in-hospital treatment and also make use of a specific network of hospitals, so when doctors charge more than medical aid rates or your make use of hospitals outside of the network, there will be shortfalls to fund.” Gap cover, he says, can help to maximise cover and reduce those co-payments and shortfalls. “Certain gap cover options and providers offer additional value, through things such as
Tony Singleton … augment. casualty benefits that cover the expense of visits to the emergency room or trauma counselling,” says Singleton. Gap cover policies are becoming an increasingly important component of medical insurance, agrees financial adviser Dawn Ridler. She believes it often makes sense to take a lower-priced medical aid plan, self-fund the day-to-day costs, but top up with gap cover. It is not necessary to use the same gap cover provider as a medical scheme provider, says
Barry Childs, joint CEO of Insight Actuaries & Consultants. “Having both your gap cover and your medical scheme membership with the same provider can make some things easier, like only having to submit the claim once to one party rather than two separate entities to each pay their part. Bear in mind, however, that sometimes using the same party comes with additional restrictions. While some additional administration is required if you use a different gap provider rather than the medical scheme provider, you shouldn’t be worse off.” Ridler explains that should medical schemes fall away if NHI is implemented as government intends, then a combination of gap cover combined with life insurance which includes dread disease cover could well step into the breach left by medical aids, if it ever comes to that. “This cover, paid out for an event, such as cancer, and therefore not a medical aid, would in effect give the member a lump sum to seek private care, even outside of the country if necessary,” she says.
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INSIGHTS: MEDICAL COVER OPTIONS FOR 2023
Increases on cards for 2023
• Most schemes have upped fees for next year, while some have announced price freeze for Q1
A Think carefully before changing medical aids It’s that time of year again when consumers have the option to change their medical aid plans — although as financial adviser Dawn Ridler points out, it’s not always that easy to simply switch plans. As disenchanted as you might be with your current medical aid scheme, do your homework before switching schemes, she says. “Moving medical aids is not easy. Unless you have resigned from a company medical aid, if you want to change medical aids — rather than plans within the same medical aid — then you are likely to get a threemonth general exclusion for anything including prescribed minimum benefits, and a 12-month condition specific exclusion.” For anyone with a chronic condition and requiring chemotherapy or dialysis, for example, this can be financially devastating. “You have to be very disenchanted with your current medical aid to want to change,” says Ridler. Her advice to existing medical aid members is to investigate what hospitals are on the list of your scheme’s network options and read the small print. “Choosing the network option can save you hundreds of rands a month without compromising on the quality of the care.” One of the biggest gripes members have with their medical scheme providers is high annual increases and what appears to be declining benefits. Although the Council for
Medical Schemes (CMS) recommended medical aids to cap their increases at 5.7%, Ridler says this is unenforceable, and therefore likely to be ignored. The majority of schemes have announced higher increases for 2023 while some have chosen to freeze their price increases for the first quarter. Ridler warns members not to be hoodwinked by so-called price freezes. “Those three months will be built into the increase next year. For example, one of the schemes delayed their increase to April next year
ONE OF THE BIGGEST GRIPES MEMBERS HAVE WITH THEIR MEDICAL SCHEME PROVIDERS IS HIGH ANNUAL INCREASES but has not yet published what this might be. Disconnecting the increase with the window of opportunity between October to mid-November to change medical aids makes it difficult for members to make comparisons.” Her biggest issue is the size of the increases which she claims medical schemes blame on high medical inflation. “For the past decade medical aid inflation has been running at 3%-4% above inflation and has become the norm. This needs investigation. Factors quoted as affecting the above average increase include an aging
population, the cost of cuttingedge medicines — which, ironically, are often unavailable on medical aids anyway, or capped at a fraction of the cost — general inflation, wage inflation and the exchange rate.” Part of the problem is that members, feeling ripped off, make sure they get value for money, especially in the higher and more comprehensive plans. She advises reading carefully through the benefits on offer. “Every year there is a superficial burnishing of benefits, so the plans look shiny and new, but over time there has been a significant erosion of benefits at each plan level. This has opened the door for gap cover which will cover the difference left by the erosion of those benefits. “One way medical aids erode their benefits is by having ‘co-payments’ and lowering the limits on certain procedures or treatments and excluding some altogether.” While out of pocket hospital expenses and co-payments can be covered with gap cover, she recommends also taking out dread disease cover — a component of life cover — that will pay out a lump sum on diagnosis of a severe illness. Not all companies are created equal when it comes to this kind of cover, she says, so it’s a good idea to use an independent financial advisor, get a number of quotes and read the small print. Encouragingly, dread disease cover stays in place even if medical schemes fall away as a result of the implementation of NHI.
t the end of July, the Council for Medial Schemes (CMS), the regulator for medical schemes, published a recommendation that medical aid contribution increases for 2023 should be limited to 5.7%, in line with the South African Reserve Bank’s average inflation rate for next year. It also recommended that schemes in a strong financial position should implement increases lower than the recommendation. The CMS justified this advisory, pointing out that in an economic environment characterised by rising inflation and interest rates, most scheme members would not be able to afford above-inflation contribution increases. Over the past decade, medical scheme contribution increases have outpaced inflation by about 4%, driven primarily by the high rate of healthcare inflation. Most schemes announced lower than usual contribution increases for 2021 and 2022 but as medical aid claims, including hospitalisations, begin to escalate, higher medical aid contributions are once again becoming the norm. Most schemes have announced higher increases than that recommended by the CMS. Some schemes, including Bonitas, Momentum Medical
Damian McHugh … accessible. Scheme and Discovery, have also announced price freezes on their increases for the first quarter of 2023. Bonitas has announced an increase of 5.9%. Lee Callakoppen, principal officer of Bonitas, says: “Our average increase for the year would have been 5.9% — well below the current inflation rate of 7.6%. The three-month price freeze effectively means an increase of 4.8% over the 12 months. We have also shared exactly what members can expect to pay from April 1 2023, so that they can make informed decisions.” The scheme’s successful hospital-at-home initiative is being extended to include a programme for re-admissions, screening and diseases prevention, an alternative to stepdown facilities and kidney dialysis at home. Other changes
introduced by Bonitas include unlimited benefits for PMB cancers on all options. In addition, the savings component has been increased by up to 9.4%, depending on the plan, and amended rules allow members to use their savings as they deem fit. Medshield Medical Scheme announced a weighted average contribution increase of 6.7% and an average 5.5% increase on specified benefits across all its scheme options in 2023. The scheme has reduced and removed co-payments on specific procedures, and introduced unlimited GP consultations for emergencies and selected conditions once members have exhausted their day-to-day or savings allocation. It has also increased benefits and made a number of enhancements to its plans. Earlier this year it launched a new hospital plan, MediSwift. “The scheme has been embracing technology to provide members with convenient access to healthcare providers through its Medshield SmartCare stable of offerings which include virtual GP consultations. A hospital-athome benefit allows members to receive hospital level treatment at home through 24/7 digital monitoring and personal care where required and a WhatsApp doctor advice line,” says Alan Fritz, acting principal
officer of Medshield Medical Scheme. Bestmed Medical Scheme has announced a weighted average contribution increase of 8.5% and a weighted average benefit limit increase of 5.7%. From 2023 the scheme will be covering mammograms on all its scheme options and has increased the child dependant age from 21 to 24. It also only requires payment contributions for the first three children in a family. Medihelp has announced that its average weighted contribution increase for 2023 will be 7.51% while benefit amounts will increase by an average of 5% on all plans. A post-hospital care benefit has been added to two its plans: MedMove and MedElect. The scheme covers dependants to the age of 26 on most plans. Momentum Medical Scheme has announced an effective 6.4% increase for 2023 and says it won’t be reducing any of its benefits. An increase of 8.5% will apply from the second quarter. Damian McHugh, executive at Momentum Health Solutions, says the scheme has adjusted its rates and reserves to account for increasing claims and monitors to ensure it is adapting to market needs. In most cases the scheme has increased benefit limits and introduced product enhancements, he adds. These
include expanding virtual GP visits from the Evolve Option to the Ingwe Option, and adding a sports injury treatment benefit to the Evolve Option. One significant change, says McHugh, comes in the launch of Multiply Inspire and Inspire Plus. “While the existing Multiply Premier model remains unchanged for members who opt to stay on a programme they have become accustomed to, Inspire (free) and Inspire Plus (available at a lower fee than Premier) are intended to bring the focus back from loyalty rewards to supporting better health. It will also become the first wellness rewards programme in the country to balance mental health and physical health in pursuing holistic wellness.” Momentum Health Solutions’ focus on accessible and convenient digital healthcare continues. Its Hello Doctor service, says McHugh, has yielded outstanding results. Available to members via the Momentum app, it provides access to an on-call doctor from a mobile device, anytime and in all South African languages. “Hello Doctor has established access to quality healthcare services in communities that rely on overcrowded state facilities. Community members can speak with healthcare professionals virtually and receive appropriate treatment.”
App bolsters scheme’s mental health offering Lockdowns imposed in a bid to curb the spread of Covid-19 affected people mentally, emotionally and physically so it is no surprise that there has been an increase in mental health related issues. It is estimated that even prior to the pandemic one in six South Africans suffered from anxiety, depression or substance use disorder. However, over the past two years, the prevalence of anxiety and depression disorders has increased by 36.4% and 38.7% respectively, according to the South African Depression and Anxiety Group (Sadag). “The increase in mental health conditions has a huge effect on employers as they try to cope with keeping their businesses going, preventing job losses and ensuring a happy and motivated workforce,” says Dr Morgan Mkhatshwa, clinical executive at Bonitas Medical Fund. “Adding an additional burden to mental health issues is economic uncertainty, political instability and poor socioeconomic conditions.” Exacerbating the situation is the fact that in SA, up to 80% of South Africans who need mental health support are unable to easily access it, according to SA’s National Mental Health Policy Framework. Medical schemes are stepping into this gap and increasing their mental health offerings. Bonitas’ Mental Health Programme is part of its managed care initiative and is aimed at improving quality of life and empowering those with mental health issues to manage their condition, offering
Your Medical Aid
We can never tell what the moment will be. But what we can tell you, is we'll be with you in those moments. education as well as support for family members. Bonitas was the first medical aid to offer members Panda, a free to download mental health and wellness mobile app that provides scientifically validated assessment tools to enable users to objectively measure their mental wellbeing. A gamified tracking tool allows the user the ability to
THE PROGRAMME IS AIMED AT IMPROVING QUALITY OF LIFE AND EMPOWERING THOSE WITH MENTAL HEALTH ISSUES TO MANAGE THEIR CONDITION
document and monitor the progress they are making on their personal mental health journey. The app allows for interactive, audio-only sessions with peers and mental health experts, assignments and videos, text-based chat support from an accredited wellness counsellor, and the ability to book one-on-one virtual consultations with counsellors, social workers, psychologists and other mental health professionals. “The level of support provided depends on the degree to which the user needs help, from easy to access to information through to advice to contact emergency services — and all using a mobile phone,” says Mkhatshwa.
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INSIGHTS: MEDICAL COVER OPTIONS FOR 2023
Affordability, sustainability a balancing act
a company that has been around for a long •timeSelect and has good reserves and solvency ratios
M
edical schemes face a delicate balancing act between keeping contribution increases affordable for members while ensuring that their schemes remain sustainable. A failure to maintain the required solvency ratio required by the CMS can have catastrophic consequences, as members of Health Squared Medical Scheme discovered in August this year when the scheme informed its members it would be ceasing operations at the end of August leaving its 14,000 members and 23,000 beneficiaries without medical aid membership. It has since come to light that Health Squared, which was established in 2019 and was the result of a merger between Resolution Health and Spectramed, had never met the 25% solvency ratio and that in the months leading up to its voluntary liquidation was overpaying its administrator and overspending on nonhealthcare-related expenditure, including on advertising. At the beginning of August, Health Squared had a solvency ratio of just 2.15%.
Lee Callakoppen … new members. Medical aid schemes going under is nothing new and happens now and again, explains financial adviser Dawn Ridler. “The medical aid field is a mature market, and because it’s so difficult to swap medical aids, the only way new entrants can build their client base is to break into the corporate market with cheap prices and waiving waiting periods.” Unfortunately, in almost all cases, she says, medical aids that tank have a solvency issue. “This is an industry where critical mass is essential if you want to lower the risk. If you can’t diversify your members,
allowing young and healthy members to effectively subsidise the older and less healthy ones, then it doesn’t take much to destabilise the medical aid.” Good administration of the medical aids is key to their success, she says, adding that this is what Discovery has got right: administering numerous closed schemes in addition to their own open scheme. “The potential for fraud in the medical aid space is high, from members overclaiming to medical professionals submitting inflated or fraudulent claims, or collusion between the two,” she says. Although the CMS has been trying to get other medical aids to take on Heath Squared clients without the waiting periods, they have met with little success. For clients with chronic conditions this is life-threatening. Ridler says this refusal could be in breach of the Medical Schemes Act, and the matter could well end up in court. Her advice to anybody looking for a medical scheme either for themselves or their employees is to select a company that has been around for a long time and has good
NHI still a ‘threat to industry’, expert warns
reserves and solvency ratios. Agreeing that the case of Health Squared was a debacle, Barry Childs, joint CEO of Insight Actuaries and Consultants, says that members of medical schemes put faith in the board of trustees to govern and manage the scheme properly in accordance with the obligations placed on trustees and, failing that, has faith in the regulator to intervene if the scheme is not being run according to appropriate standards. “Unfortunately, in the case of Health Squared, neither faith was borne out as interventions were far too late. Fortunately, most of the time trustees and even the regulator step in early enough to protect members and prevent disaster when a scheme is running into financial trouble,” says Childs. Medical scheme members should be active participants in the governance of their scheme, taking part in trustee elections and paying attention to management information and financial security, he says. “Generally speaking, a scheme with reserves at or above the required regulatory minimum — 25% of total contributions — and some stability in that reserve ratio with no wild fluctuations on the solvency ratio or a steady trend of decline of the solvency ratio,
are sufficiently secure.” Childs adds that medical scheme failure does not happen overnight, so keeping an eye on a scheme’s financial health is important. Promoting sustainability in the healthcare industry is key, says Bonitas principal officer Lee Callakoppen, adding that the scheme has high solvency ratios, strong reserves and a high claims paying ability. “Not only is Bonitas financially sound with more than R7.4bn in reserves, but over the past 36 months we have signed up 190,000 new members. This figure is significantly higher than the size of most schemes in the industry.” Even better for sustainability is that the average age of its new members is about 15 years younger than the current membership. This, says Callakoppen, reinforces the fact that the scheme is succeeding in attracting a younger, healthier profile, which is coveted across the industry.
MEDICAL SCHEME FAILURE DOES NOT HAPPEN OVERNIGHT, SO KEEPING AN EYE ON A SCHEME’S FINANCIAL HEALTH IS IMPORTANT
One of the biggest threats to the medical scheme industry is government’s proposed National Health Insurance (NHI), an industry expert warns. Earlier iterations of the proposed NHI bill stated that “once National Health Insurance has been fully implemented … medical schemes may only offer complementary cover to services not reimbursable by the fund”. “The ruling party keeps pulling NHI off the back burner in what I believe to be a thinly veiled attempt to buy votes,” says financial adviser Dawn Ridler. “This charade has been going on since 2005, but at no time has anyone from government attempted to put realistic numbers to this scheme — because they know it would be unaffordable. Each taxpayer in our overburdened, shrinking tax base already pays for two grantees.” Government expenditure on healthcare is about R260bn per annum, second only to education. Unlike education, where taxpayers can choose to pay extra for private education fees, NHI would, according Ridler, to all intents and purposes, destroy the private health scheme industry. “The quality of government education is as big a problem as the quality of government healthcare but you can still choose to buy private care. When you start to interfere with a taxpayer’s free choice and access to quality health or education you are going to see emigration. These are those deal-breaker issues.” Medical aids cover about 9million people, who collectively paid medical aid contributions
of about R230bn in 2021 through average premiums of an estimated R2,105 per person. “Should government be able to get their hands on the premiums medical aid members pay it would double their health budget to just under R500bn. New NHI proposals suggest an incremental premium depending on how much you earn — but with no commensurate increase in benefits — perhaps with a cap. In other words, if you are in a higher bracket, you are likely to be taxed more for NHI than you are currently spending on medical aid, especially if you are not on a top tier plan.” Medical aids are legally required to a keep a quarter of all contributions in reserves. Covid restrictions resulted in a huge increase in reserves as members delayed surgeries and treatments. Discovery, for example, increased its reserves from R1.9bn to R9.1bn during this period. The collective reserves of medical schemes are estimated to be in the region of R100bn. “This is money government would love to get their hands on, although they will have to find a way to get round the fact that this would be appropriation without compensation given
that those reserves belong to the members rather than the medical aids,” points out Ridler. She adds that the continued erosion of the medical professional base is not expected to stop. “If the NHI is shoehorned though, that trickle will turn into a flood. The NHI recommendations will have a huge impact on the remuneration of all medical professionals and companies. In the current format, the NHI will effectively destroy private medical practice and medical aids.” The National Planning Commission (NPC) has said that the proposed NHI Bill to limit the role of the private sector has significant implications for both the South African economy and the private healthcare sector. It has recommended that the medical scheme industry should be allowed to continue operating indefinitely and believes SA would be better served by ‘harnessing’ private healthcare facilities rather than phasing them out solely in favour of the government-run NHI. The commission has advised introducing regulation to improve efficiencies and better manage costs. The NHI Bill is currently undergoing a public consultation process.
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