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The Council for Medical Schemes(CMS) hasbeen working ona framework which would exempt schemes from offering PMBs and allow them to offermore affordable plans, something which medi- calschemes arguewouldalleviatepressure onthealready over-burdened publichealth sector.

Thebig questionnow,how-

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■ From Page 14 ever, iswhat rolemedical aid schemes will play if the government pushesahead with the implementationof NationalHealthInsurance(NHI).

Writingin herweekly newsletter recently, Business Leadership SACEO Busi Mavuso said: “The charade continues itsabsurdity. Ican assure youthat it willend up in no improvementsto healthcare qualityin SA, infact the riskispreciselytheopposite.”

If thegovernment isserious about delivering improved health care, shesays, there are “betterways todo it,involving partnershipswith theprivate sector”

Discovery estimatesthat a modestNHI wouldcost R200bn, says Mavuso, “which would requirepersonal taxes to go up by athird or VAT to riseto21.5%,or amixofthe two”

Lee Callakoppen,principal officeratBonitas,saystheNHI and private medical schemes can andshould coexist.

“Curtailing the role of medical aids in SAwill have significant ramifications not only on thechoice ofcitizens regarding management of their healthbut alsotheeconomy. Medical aidsand theirassoci- atedservices makeanenormous contribution to the annualfiscus, employmentand theeconomy,”hesays.

Critics of theNHI Bill say that it has nottaken into accountthenumerousobjections madebya numberofdifferent stakeholders. It is not clear on whatwilland willnotbeoffered byNHI andthe role if any thatprivate medical aidswillplay.

The governmentenvisages that NHIwill bephased in over several years,offering an expandingbundle ofservices astime goeson. Theofficial planisfor twophases.The first, due to start this year and rununtil2026, issupposedto prepare the groundand start deliveringfor onlyselected groups: children,women, the elderlyand peoplewithdisabilities. Forthem, healthcare services are supposed to be boughtfromtheprivatesector.

Phase 2, dueto run until 2028, is supposedto broaden the contracting of health servicesfrom privateproviders beyond these groups and set up the “mandatory prepayment”system thetaxeveryonewillhavetopaytofundthe NHI.

“In its currentform the bill limitsthe roleofmedical schemes. In fact,medical aids asweknow themwillbe scrapped because theywill not beallowed tocover thehealth servicestheNHIpaysfor.This meansmedical aidmembers will beforced to relyon the NHI once it kicks in,” says Callakoppen.

Thereisno questionthatthe collective strengtheningof funds belong to the members ofthoseschemes.

DamianMcHugh,executive headofmarketingatMomentumHealthSolutions,hasa similartake,explainingthat whiletakingstepstouniversal healthcoverageistheright thingtodotoprovidemore healthformorepeoplefor the government,” says McHugh. He saysthe introduction of low-costbenefits is an immediatefirst stepthat will improve accessto health care,while incrementalsteps towards theimprovement of public healthservices mustbe takentoimproveaccesstocare forallpeople.

A number ofprivate healthcarecompanieshaveofferedto collaborate with the government to ensurehealthcare excellenceand toretainexpertisein thehealthsystem tothe advantageof allSouth Africans.

AsCallakoppen pointsout, NHIis afundingmechanism ratherthan universalhealth coverage. “A multitudeofinterventions need tobe consideredtosupporttheprogresstowardsuniversal healthcoverage including strengthening existing healthsystems, quality standards,governance and management capacity, all of which requireequal attention and willcontribute independentlyto advancinguniversal healthcoverage,”hesays.

The funding industry, he says,has extensiveexperience andexpertiseinfinancing,value-based care,management and administration,which willbevaluabletoreformsthat lieahead.