Healthcare legislation changes – what these mean for you

In the past, we have communicated with members around industry developments such as the proposed National Health Insurance (NHI) Fund, as well as the Competition Commission’s health market inquiry. For quite some time the news around these developments has been unspecific, and we could basically only tell members to “watch this space”. However, in recent months the long-awaited provisional report by the Competition Commission was released, and health minister Aaron Motsoaledi presented both the National Health Insurance and the Medical Schemes Amendment Bills. These three developments are interrelated – but what do they mean to members?

National Health Insurance (NHI) Bill and the Medical Schemes Amendment Bill

The National Health Insurance (NHI) Bill aims to establish a state-run fund that ensures sustainable and affordable universal access to health services for all South Africans. The Medical Schemes Amendment Bill has been drafted in tandem, to facilitate the move towards state-run medical care. At this stage there is still much speculation and uncertainty, as the bills are still open for public comment and may look different in their final iteration. Once again we need to tell members to “watch this space” for more specific details, once they are known. But we do know a few things…

  • The Plan is to have the National Health Insurance Fund in place by the end of 2022.
  • All RSA citizens and permanent residents will belong to the NHI Fund.
  • Those who earn an income will contribute to the NHI Fund.
  • It will require a massive shake-up to both the governmental and the private healthcare systems.
  • Medical schemes will have to change shape to adapt to the new environment.
  • An expanded set of Prescribed Minimum Benefits will be formulated.
  • There will be a strong focus on setting uniform tariffs for healthcare providers.

The Competition Commission’s health market inquiry

Following a four-year investigation into the private healthcare sector, the Competition Commission has released its preliminary report. The 800-page report is a bit too long to detail here, but in short…

One of the recommendations in the Competition Commission’s health market inquiry has been for medical schemes to change the way they structure their various options, so that all the different options can be compared more easily, and competition in the market can be increased.

The inquiry has also found that over-servicing (in the form of increased admissions to hospitals, increased length of stay, higher levels of care, greater intensity of care, and the use of more expensive forms of care than necessary) by doctors, specialists and other medical practitioners is one of the factors that have driven up private healthcare spending. For example, South Africa’s rate of admission per person is double that of the United States, and seven times that of European countries.

Another recommendation was for the introduction of a stand-alone, standardised, “base” benefit package that all medical schemes must offer, and which would offer prescribed minimum benefits that would include primary and preventive care.

We will continue to monitor further developments and communicate these to members.