Why your medical costs are soaring

2012-08-04 16:14

 A North Gauteng High Court ruling in November forced providers to abide by the law


South Africans are fed up with paying massive premiums and getting poor service from medical-aid schemes – and they’re gearing up for a fight.

Ordinary people have taken some of the country’s biggest medical aid schemes to court in two cases that could change the way the private healthcare sector operates.

But Health Minister Aaron Motsoaledi this week warned that court battles were not the way to make private healthcare cheaper.

Speaking at the Board of Healthcare Funders’ (BHF) conference in KwaZulu-Natal this week, Motsoaledi said: “The solution does not lie in court cases.”

One case, which is before the Supreme Court of Appeal, relates to the contentious issue of ­prescribed minimum benefits (PMBs).

PMBs are a list of 295 conditions that medical schemes must legally cover and pay in full, regardless of which benefit option the user is on.

But it took a North Gauteng High Court ruling in November to force providers to abide by the law – until then, many schemes paid service providers what they deemed fit, rather than covering full costs.

This left patients out of pocket as they forked out the difference.

Referring to this case, Motsoaledi said: “That judgment is just going to increase health inflation in the country.
It is going to force you to raise premiums and citizens will suffer.”

The battle over PMBs started when members lodged complaints with the Council for Medical Schemes.

The council is there to protect the public, and it took the matter up with the schemes.

But no solution was found.

Instead, the Board of Healthcare Funders, which represents more than 80% of South Africa’s medical schemes, took the matter to court.

It asked the court to clarify whether PMBs should be paid in full, and the council opposed the application.

The court ruled in the council’s favour and, in May, the board applied for permission to appeal the ruling.

This was denied, and it has now lodged another application with the Supreme Court of Appeal.

The matter is pending.

BHF spokesperson Heidi Kruger this week told City Press: “Medical schemes that are being forced to pay in full for PMBs at whatever cost the healthcare provider charges are facing an uphill battle to manage spiralling costs.

“Since medical schemes are cooperatives which consist of member money, these costs will eventually have to be absorbed by members. This has the potential to make medical scheme membership unaffordable to a larger majority of the South African population,” Kruger said.

But it’s not just PMBs that have placed medical aid schemes firmly in the firing line.

The National Consumer Commission has taken schemes to the Equality Court on behalf of the public.

The commission claims that schemes – among them Bonitas, Momentum, Medshield and Fedhealth, as well as the council itself – are discriminating against pregnant women by refusing to cover their maternity costs if they joined the schemes during their pregnancy.

It also wants schemes to stop charging late-joiner penalties, including foreigners.

The council said in a statement that its legal team was currently studying the court papers and would “discuss the matter with both the consumer commissioner and the minister of health”.


Big schemes are eating up the little ones
Medical schemes in South Africa are shrinking every year – and it seems bigs chemes are swallowing up their smaller competitors.

There were 100 registered medical schemes in 2010, down from 110 in 2009 and 120 in 2008.

And the Council of Medical Schemes says the trend is likely to continue.

Just this week, Resolution Health Medical Scheme (Resolution Health) and the National Independent Medical Aid Society (NIMAS) merged.

The five biggest medical aid schemes, though, are growing.

These are the schemes listed as the five largest by membership by the Council of Medical Schemes.

1 Discovery – 2.4 million members
2 Government Employees Medical Scheme – 1.5 million members
3 Bonitas – 618 464 members
4 Polmed – 476 385 members
5 Medshield – 261 805 members



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