Officials ‘demonise’ medical schemes

A succession of health ministers has deliberately promoted false claims about medical schemes to bolster the ANC government’s case for National Health Insurance (NHI), concludes research presented at the annual Board of Healthcare Funders (BHF) conference under way in Cape Town this week.

These include assertions that the medical scheme industry is on the verge of collapse, that beneficiaries routinely run out of benefits midyear and are dumped on the state, and that most medical scheme members are white.

The BHF is one of SA’s key industry associations for medical schemes and administrators, with members that collectively represent half of SA’s 9-million medical scheme beneficiaries. It commissioned independent research to counter the government’s “sensationalist and emotive” narrative about medical schemes, said BHF MD Katlego Mothudi.

“We were not comfortable with the finger-pointing and what we knew was not factual,” he said.

The analysis was conducted by Wits governance expert Alex van den Heever, who said: “There is a pattern to demonise the medical aid system, to make it look as if it is collapsing and could never form part of [universal health coverage] in the context of NHI.”

While many of the statements were hyperbolic and not backed up by systematic research or evidence, they nevertheless carried weight because they were made by individuals in positions of power, he said.

The government’s plans for universal health coverage are set out in the NHI Bill, which was passed by parliament in December 2023 and now awaits the president’s signature to become law. One of the bill’s most controversial aspects is its sharply diminished role for medical schemes, which are restricted to providing cover only for services not provided by the NHI.

HIGH-LEVEL FINDINGS

Van den Heever’s report for the BHF has not been made public, but he presented the high-level findings to conference delegates on Sunday. The analysis was restricted to comments made since 2008 by health ministers, deputy health ministers and former NHI ministerial advisory committee chair Olive Shisana, as they wielded political power and were the key decisionmakers on the policy, said Van den Heever.

He identified 11 sets of frequently repeated claims that he concluded were unsubstantiated and untrue. These include the assertion that the medical scheme system is unviable and failing, which is not borne out by the evidence, he said. The industry had remained stable between 2005 and 2022 on all the key indicators, he said.

The number of medical scheme beneficiaries increased by 1-million between 2009 and 2022, medical scheme reserves stood at 49.2% of gross consolidated income in 2022, well in excess of the 25% statutory requirement, and total nonhealthcare expenditure per

49.2% medical scheme reserves — as a percentage of gross consolidated income

25% the statutory requirement

beneficiary per month had declined 37.4% in real terms between 2005 and 2020.

The claim that most medical scheme members are white is wrong, he said. Stats SA data shows 50.2% of medical scheme beneficiaries are black African and 32.3% are white, he said.

Similarly, claims that medical scheme members frequently run out of benefits midyear and are “dumped” on the state were false, he said.

The lion’s share of medical scheme claims is covered by a basket of care known as the prescribed minimum benefits, which schemes are legally obliged to cover in full.

Moreover, there has been a systematic decline in medical scheme beneficiary use of public hospitals, and the health department has done no research to back up its assertions, he said.

Deputy health minister Sibongiseni Dhlomo, who attended the conference on Sunday night, dismissed Van den Heever’s analysis.

“I would not expect anything less from Prof Alex van den Heever, because he is already a known consultant of the DA on NHI, so his stance would not be different from that of the DA.

“I would not really engage with his presentation, because he is not a clinician,” he said.

Van den Heever said the deputy minister was seeking to deflect attention from the issues raised by the research with a personal attack.

“As an expert report, it should be responded to on its merits,” he said. “I have been asked for advice by multiple political parties and organisations on health reform and other areas of public policy, including by the ANC.

“This is ... ongoing and arises because many organisations want a better understanding of these complex issues. This was an expert report commissioned by the BHF and has nothing to do with any other organisation.”