Picture: 123RF/SAMSONOVS
Picture: 123RF/SAMSONOVS

The medical schemes regulator has revived a controversial plan to establish a central database of scheme members and is once again calling on schemes to provide personal details about their members.

The idea of a central database was first flighted by the Council for Medical Schemes (CMS) in 2017 and ran into immediate opposition from the DA and several schemes, who expressed concerns about what the data would be used for, and the potential infringement on members’ privacy.

The CMS is a statutory body charged with overseeing the R180bn medical schemes industry, which provides cover to about 8.9-million people.

It is pushing ahead with its plans for a national beneficiary registry, which it says will ultimately link to a patient registration system that the government plans to establish under National Health Insurance (NHI).

It is expanding a pilot programme that began several months ago with SA’s biggest medical scheme for civil servants, the Government Employees Medical Scheme (Gems).

In a circular issued on July 9, the CMS called on other schemes to register for the pilot programme by end-August. It wants schemes to start by providing data on 10,000 members, and once the initial kinks have been ironed out, transfer a second tranche of information on the rest of their membership base by end-February.

CMS spokesperson Grace Khoza said the regulator is taking “the best possible” measures to protect members’ privacy and ensure their information does not end up in the wrong hands.

Limited data

CMS chief information officer Jaap Kugel said the data required of schemes is “very limited” and will not include any clinical details. It has asked schemes to provide information such as patient names, identity numbers and addresses, he said. The beneficiary registry will give every medical scheme member a unique identifier, to be kept for life.

Kugel said the registry will enable state facilities to check whether patients belonged to a medical scheme, track the movement of members between schemes, and make it easier for the CMS to communicate with members. 

Gems principal officer Guni Goolab said “very minimal” data from the scheme’s members has been provided to the CMS to date, and none of it is health related. The focus has been on figuring out the technical aspects of feeding data into the CMS system, he said.

“We have done a number of tests, and lessons have been learnt. It’s ongoing work,” he said.

The Board of Healthcare Funders, an industry association for medical schemes and administrators, previously expressed reservations about the plan. However it has yet to formulate a position on the current proposal, said the head of its risk and benefit department, Rajesh Patel.

“It all depends on what the information is to be used for,” he said.

SA’s biggest medical scheme administrator Discovery Health said that it is engaging with its client medical schemes and will engage with the CMS in response to the Circular.

kahnt@businesslive.co.za