Alternative organisation to compete with BHF

As the Board of Healthcare Funders (BHF) held its annual conference in Cape Town this week under the banner "A roadmap to Universal Healthcare", sources said an alternative organisation representing schemes and their administrators was in the process of being established and was expected to be launched this year.

It was expected that this organisation would take a stronger line in promoting the role of medical schemes as a funder of private healthcare under the National Health Insurance (NHI). The BHF's membership roll revealed that it has lost some support as more schemes and their administrators have left the organisation. The BHF now represents 48 out of 83 South African medical schemes, seven administrators and one managed care organisation. It also includes a few medical schemes and administrators from neighbouring countries, such as Zimbabwe, Botswana and Namibia.

Discovery Health Medical Schemes and its administrator left the organisation about four years ago, and the membership roll revealed that Momentum Health and its administrator, as well as Profmed, Fedhealth, LA Health and Transmed, were no longer members. However, the Government Employee Medical Scheme, covering 1.75-million lives, recently joined the BHF.

In terms of medical scheme membership (based on information in the Council for Medical Schemes's annual report for 2014/15), BHF member schemes represent about 45 percent of all medical scheme members. Former Finance Minister Nhlanhla Nene, now an adviser to Thebe Investment, which includes Thebe Ya Bophelo Healthcare Administrators, told the conference that private healthcare providers, including the medical scheme industry, should fight to participate in the creation of a better healthcare system. He said healthcare cost escalation is rampant around the world, and noted that medical scheme costs in South Africa had risen by 300 percent in the past 12 years to R142-billion.

The overall budget expenditure in the public sector has increased from R20-billion in 2000 to R170-billion this year - an escalation of more than 850 percent. With this level of expenditure, why are we seeing a paucity of outcomes? he asked. Nene pointed out that the significant disparities in access to healthcare, which manifested in 84 percent of South Africans relying on the services of the 30 percent of doctors who worked in the public healthcare sector. At the conference, which focused on NHI as the way to ensure that all South Africans can access quality healthcare services, Vishal Brijlal, the leader of an NHI task team set up by the Department of Health to consider the role of medical schemes in NHI, called on schemes, administrators and other private healthcare providers to engage with the department's team on how to implement the NHI policy once it had been adopted and transition from the current system to a new one.

The draft White Paper on NHI released for discussion late last year proposed that, under NHI, medical schemes would be confined to complementing or topping up the services provided through NHI. Brijlal said the current thinking was that schemes should complement rather than compete with NHI, but he was not able to say how the NHI policy in the draft White Paper would change before it was finalised with regard to the role of medical schemes.

Dr Anna Mokgokong, the chairwoman of the Afro Centric Group, said the healthcare industry was in a state of "analysis paralysis" over the path to universal healthcare. However, the private and public sector needed to come together to bring about universal healthcare, because they were "important cogs in the wheel". If the private healthcare sector did not participate in the formulation of NHI, it would be excluded, she said.

Business Report, 22 July 2016