18 November 2018


Relief for troubled patients as NHI draws nearer

by: SAnews.gov.za   date: 29 june 2018

Health Minister, Dr Aaron Motsoaledi, says the Medical
Schemes Amendment Bill and the National Health Insurance
(NHI) Amendment Bill will introduce measures that will lift a financial burden
from beneficiaries subjected to high healthcare costs.

Briefing members of the media in Pretoria last week, Motsoaledi, said the cost of private healthcare was out of reach of
many citizens, with former Chief Justice, Sandile Ngcobo, having been appointed
by the Competition Commission to conduct a market research into the cost of
private health care.
The World Health Organisation (WHO) and the Organisation for Economic Cooperation
and Development (OECD) have found that only 10% of South Africans
can afford private health care. “The amendments we are introducing
are meant to provide much needed relief to patients finding themselves in serious
financial hardships,” he said. What the Medical Schemes Amendment Bill will mean for

Motsoaledi said first amendment to the Bill would abolish co-payments, meaning the scheme pays a portion of the bill that a provider - be it hospital or private doctor
- charges a patient. The rest of the funds are supposed to be paid by patients from their own pocket.
“The amendment means that every cent charged to a patient must be settled in full by the scheme and the patient should
not be burdened with any payment.

There are people who will scream that this amendment is outrageous and calculated to destroy medical schemes and
leave beneficiaries with nothing. I want to assure you that this was well thought of,”
he explained.
He said according to data at the department’s disposal, medical schemes are
holding close to R60 billion in unused reserves.
While there is a statutory requirement that medical schemes should have 25%
of their income in reserves - a fund that caters for emergencies - presently, the
R60 billion is equivalent to 33% in reserves
- an unnecessary accumulation at
the expense of patients.
The Council for Medical Schemes is 
busy reviewing the 25% statutory requirement,
with a view to releasing enough
money for patients rather than holding a
lot of reserves.
The Minister said another amendment
would abolish the practice of using brokers within the medical schemes environment.
“Almost two thirds of principal members of medical aid schemes pay monthly to
a broker as part of their premium. Many of these members do not even know
that they are paying this money, which in
2018 is R90 per month. The total amount
paid to brokers in 2017 was R2.2 billion,”
he said.
He said the money should be made available to be paid for direct health expenses
of members rather than serving brokers who are actually not needed in
the healthcare system.
Another amendment, according to Motsoaledi, will compel medical aid schemes
to pass back savings if a member uses
a designated service provider, in accordance
with the rules of the scheme.
“Presently, medical aid schemes compel members to use designated service
providers in order to save money. This is
a good practice to be encouraged however, the problem is, these savings are
taken over by the scheme or the administrator
instead of being passed on to a member in the form of a premium reduction,”
he said.
NHI to curb cost, improve quality
of healthcare
NHI is a health financing system that
pools funds to provide access to quality health services for all South Africans
based on their health needs, irrespective of their socio-economic status. 

Motsoaledi said government was painfully
aware of the fact that some people believe that even before speaking about
the NHI, there was a need to fix the ailing
public healthcare system first.
He said government was alive to the
problems of poor quality and lack of efficiency in the public healthcare system.
Motsoaledi said the poor quality of
healthcare and the existing cost of private healthcare need to be addressed.
“Clearly, the NDP regards these two as the terrible twins of the healthcare system,
hence the need to be tackled simultaneously.
If we do them one after the
other, it means we are planning to take the next half century before we talk about
NHI. That is undesirable,” he said.
In the massive reorganization of the healthcare system, 12 Acts have been
identified as laws that should be amended for the healthcare system to be able to
run smoothly.
Two of the 12 Acts include the National Health Act of 2003 (Act No. 61 of 2003) and the Mental Health Act, 2002 (Act No.
17 of 2002). The amendment of these Acts also forms part of the Health Ombud
recommendations in the aftermath of the Life Esidimeni tragedy.

“The National Health Act, as it stands currently, empowers the Minister of
Health and the national department to come up with policies, guidelines, norms
and standards for implementation by various provincial departments of Health.
“The act also provides for the establishment of the National Health Council consisting of the Minister and MECs, the
Director-General and HoDs, as well as the Sergeant General of the South African
Military Health Services and SALGA.

The functions of this body is to advise the Minister on a broad range of issues pertaining
to the running of the healthcare system,” Motsoaledi said.