The Medical Schemes Amendment Bill has been gazetted for public comment, setting in motion a potentially contentious debate between the government, industry and consumer groups over how best to protect patients from catastrophic medical expenses.
Briefing reporters ahead of the release of the bill, Health Minister Aaron Motsoaledi said the changes were intended to give greater protection to medical scheme members and ensure more of their monthly premiums was spent on healthcare, rather than broker fees or accumulating medical scheme reserves.
Medical schemes currently hold R60bn in reserves, equivalent to 33% of their annual premium income and far in excess of the 25% threshold currently required by law, he said. This was an unnecessary accumulation of reserves at the expense of patients, the minister said.
Health Minister Aaron Motsoaledi outlined changes proposed in the Medical Schemes Amendment Bill at a media briefing on June 21 2018. Here are six you need to know about.
The total amount paid to brokers in 2017 was R2.2bn, said the minister. "We want this money to be made available to pay for direct expenses of members rather than serving brokers who are actually not needed," he said.
The bill proposes scrapping co-payments, banning brokers and devising a new set of mandatory benefits that would emphasise primary healthcare cover. It contains provisions that if implemented, would see greater cross-subsidisation within medical schemes, so that people on lower incomes paid lower premiums than people on higher incomes for the same benefits, he said.
"The essence of NHI (National Health Insurance), which must start now even with the present medical aid schemes, is that the rich must subsidise the poor, the young must subsidise the old and the healthy must subsidise the sick," Motsoaledi said.
The bill also contains measures to strengthen the governance of medical schemes, with new minimum education requirements for trustees.