Medical costs: Employees ham in sandwich

Employees who are members of medical schemes enjoy some protection against higher tariffs set by their healthcare providers. Now Health Minister Aaron Motsoaledi has proposed amendments to Regulation 8 of the Medical Schemes Act. If implemented they could expose employees to rising costs without adequate cover from the medical schemes. The regulations will limit the liability of medical schemes to the rates set in a 2006 tariff guide called the National Health Reference Price List, adjusted for consumer price inflation. Medical schemes can, but are not obliged to, negotiate higher tariffs with healthcare providers to protect members from co-payments. In the opinion of health economist Alex van den Heever, chair of social security system administration and management studies at the University of the Witwatersrand School of Governance, the draft regulations will reduce some financial risks faced by medical schemes for prescribed minimum benefits and shift the burden onto employees who do not have the power to negotiate with healthcare providers.

Read Tamar Kahn’s full report Medical aid change to benefit funders first published today on BD Live.

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GilesFiles on July 23, 2015 at 4:15 pm

Writing in BDLive today Bronwyn Nortje comments on the draft regulation; see Medical aid tweak a sign of health.

In an ideal world, research and consultation should always play a significant role in the drafting of any policy, but sometimes even with the most generous of consultative processes only time will tell whether an intervention has achieved its desired outcome.

As is very clear in the heated debate over the amendment to regulation 8, vested interests and individual agendas can muddy the waters because they create an incentive for stakeholders to overstate the benefit or burden of a proposed change in legislation. For this reason policy should always be an iterative process.

If over time it becomes clear that a change in legislation has benefited one party to the detriment of another, there is no question in my mind that it needs to be reassessed. In the case of the regulations governing PMBs, it would seem that not only has the existing regime placed an undue burden on the medical aid schemes, it has in the process also undermined the minister’s goal of providing as many South Africans as possible with access to high-quality healthcare, and this is certainly something that needs to be addressed.

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Medical costs: Employees ham in sandwich

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