Fears new medical aid law changes may cause 'doctor drain'

The Medical Schemes Amendment Bill is now in Parliament.
The Medical Schemes Amendment Bill is now in Parliament.

Concerns have been raised about the proposed Medical Schemes Amendment Bill, one of many health-related bills which have been going through various motions in Parliament.

Recently, the cabinet approved the Bill to regulate medical schemes, and it will now be published and made available for public comment.

Among the concerns raised is the impact of a proposed uniform tariff for healthcare services, leading to a possible exodus of doctors and other healthcare professionals to countries where they can get "full value" for their services by charging tariffs they see as reasonable.

Uniform tariffs

Head of Healthcare at financial service company GTC, Jill Larken, told Health24 that a uniform tariff was introduced into the pharmaceutical industry some time ago with a standard single exit price set for each medicine.

"Although there was substantial pushback, this was eventually adopted and has seen the effective management of medicine prices.

"To extend this concept into the pricing of services paid to some of the rarest professionals in our country would surely cause those professionals to seek employment elsewhere in the world.

"This 'brain drain' is not a new concept to South Africa, but we cannot continue to suffer the loss of doctors and an increase in population. We don't currently have enough doctors to cater for our existing population, which currently means that those who do decide to stay, will forever be overworked,” said Larken.

Managing Director for the Board of Healthcare Funders (BHF), Dr Katlego Mothudi, told Health24 that the Bill needs to be amended. "There are many sections that need to be aligned to good health policy and remove barriers that impede access to affordable care."

Mothudi added that healthcare expenses have been increasing at rates of 4% to 5% above inflation over the past years.

"There are inadequate controls to manage the increasing costs of healthcare, so the proposed uniform tariff would help address this problem to some extent. The implementation of uniform tariffs would avoid co-payments as medical schemes would reimburse providers at the prescribed tariffs," said Mothudi.

But tariffs aren't the only issue

The proposed Amendment Bill addresses doing away with prescribed minimum benefits (PMB) and replacing it with basic benefits.

The Council for Medical Schemes describes PMBs as a list of benefits that members of medical aids, regardless of the package they're on, have access to. The website adds that PMBs form part of the Medical Schemes Act and states that medical aids are obliged to cover the costs related to the diagnoses, care and treatment of any emergency medical condition, 270 medical conditions and 25 chronic conditions.

The Amended Bill aims to replace PMBs with something called basic benefits.

Mothudi said that the major weakness with PMBs is that they are "hospi-centric" and it would be more efficient to provide primary care and prevent avoidable hospitalisations.

Health Minister, Dr Aaron Motsoaledi, or the Department of Health is yet to let medical aids know more about the basic benefits, according to Larken.

"We have been informed that basic benefits would replace PMBs at some point in the future. We have not been supplied with a list of these basic benefits, neither have the medical aids, who will be expected to make adjustments to their minimum benefits and premiums as and when this list is released," said Larken.

Effect of removal of co-payments

Larken added that with this comes the eradication of co-payments, and without co-payments every member would be asked to pay much higher premiums.

"Via the introduction and charging of co-payments, medical aids have been able to manage the annual premium increases experienced by their whole membership, and transfer some of the risk back onto those members which require the co-payment procedures.

"The only tie in between the basic minimum benefits, uniform tariffs and co-payments would be if, and here it is a very big if, these elements were all released at the same time.

"The effect of the introduction of basic minimum benefits, uniform tariffs and co-payments would be to reduce premiums for medical aid members, whereas the effect of the removal of co-payments would be to increase premiums for medical aid members," said Larken.

When the amendment to the bill was announced in 2015, rights organisation Section27 released a statement saying that regulation eight (8) is unreasonable.

The organisation listed several reasons behind why the legislation is unreasonable, one of them being that the proposed amendment undermines the important purpose of the Act, which includes to "protect the interests of medical scheme members".

Image credit: iStock

We live in a world where facts and fiction get blurred
In times of uncertainty you need journalism you can trust. For only R75 per month, you have access to a world of in-depth analyses, investigative journalism, top opinions and a range of features. Journalism strengthens democracy. Invest in the future today.
Subscribe to News24
Voting Booth
Have you entered our Health of the Nation survey?
Please select an option Oops! Something went wrong, please try again later.
33% - 9324 votes
67% - 18755 votes