Today's Big Stories

The medical aid debate intensifies

Experts in the medical aid industry have been weighing up reasons as to why healthcare is so expensive and why the industry is in trouble.

Dr Humphrey Zokufa, Chief executive of the Board of Healthcare Funders and Dr Mark Sonderup of South African Medical Association both addressed the issue.

Zokufa said medical aid schemes are at risk of collapsing because members of medical aids aren’t satisfied.

The problem is with regulation, fees aren’t regulated in the industry and we want them to be regulated in terms of what they charge.

Dr Humphrey Zokufa, Chief executive of the Board of Healthcare Funders

Sonderup then asserted that the cost of healthcare is expensive.

He argued that doctors can’t solely be blamed for expensive healthcare.

Do we need more legislation to regulate the minority who are overstepping the line? Deal with the few bad apples in the box.

Dr Mark Sonderup of South African Medical Association

Zokufa then said more than 60 percent goes to the specialists and private doctors.

“There is no legislation that states what you can or cannot charge. That is where the gap is. We need legislation in place. There is no transparency in terms of how much doctors charge for what.”

THE SUGGESTED CHANGES TO MEDICAL SCHEMES ACT

In July, Health Minister Aaron Motsoaledi published draft amendments to Regulation 8 of the Medical Schemes Act.

The regulation currently forces medical aid schemes to pay in full for whatever the doctor charges for diagnosing and treating conditions that fall under the Prescribed Minimum Benefits (PMBs).

• PMBs are a basket of healthcare services that medical aid schemes must provide to their members, including around 270 common medical conditions, 25 chronic conditions and emergency care.

• But the proposed changes, if accepted in their current form, will limit medical aid schemes’ payment liability, sparking fears that patients will no longer be certain that their emergency, chronic conditions or even cancer treatments will be paid in full.

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