HFA CEO, Lerato Mosiah

The Health Funders Association (HFA) says it envisages that
the Health Market Inquiry’s (HMI) Provisional Report that will be released tomorrow
will promote the sustainability of the healthcare funding industry and
contribute to the effective pursuit of Universal Health Coverage (“UHC”) in the
best interest of all South Africans. The HFA represents a collective membership
base of 53% of South Africa’s medical scheme principal members.  The HMI’s long-awaited preliminary findings
and recommendations on the private sector will be released for public comment at
a media conference in Sandton tomorrow morning (5 July).

Speaking in the context of the recently released Medical
Schemes Amendment Bill, HFA CEO, Lerato Mosiah noted that while the Bill seeks
to make private healthcare more affordable by removing co-payments on certain
benefits and adjusting when waiting periods can be applied, these provisions in
isolation, have the unintended consequence of threatening the sustainability of
medical schemes. “While we welcome the dialogue in the sector, it is critical that
this takes into consideration the broader picture and context. It is thus
important to understand that medical schemes utilise risk management measures
in order to ensure that they remain viable. Tampering with these limited
measures in isolation would accelerate the erosion of reserves and leave
medical schemes with very few options to maintain sustainability.

We are looking forward to the HMI
report which we hope will recommend interventions that will ensure the industry
remains viable in support of UHC. These
could include a mechanism for
negotiating doctors’ and hospital charges more effectively, and mandatory
medical scheme membership for people earning above a certain threshold,” she
added.

Legislation governing medical schemes, despite its limitations,
has been successful in ensuring that members are safeguarded in several ways.
These include provisions in the Medical Schemes Act to ensure that members are
not discriminated against according to their risk and age profile and that
every member is entitled to a specified set of hospital, emergency and chronic
benefits.

Notwithstanding, these provisions which protect consumers,
should have been counterbalanced in the Act by provisions which keep medical
schemes sustainable to ensure ongoing protection of consumers, Mosiah noted.
Enhancements that could have been included are compulsory membership, a risk
equalisation mechanism and a framework for healthcare tariffs. Medical schemes
have a bigger and critical role to play in increasing access to quality
healthcare for more South Africans.

“Between medical schemes, doctors and hospitals there is
sufficient data to be able to publish information on quality which would enable
consumers to make educated choices when it comes to choosing their healthcare
provider. It is therefore my hope that the HMI recognises this and makes
recommendations to government to enable a sustainable industry that contributes
to long term benefits to consumers of healthcare products and services,” Mosiah
concluded.

The HMI’s media conference will be held at 10h00 tomorrow at the Hilton
Hotel, 138 Rivonia Road in Sandton.