Regulator gets report on cheap options

The medical scheme regulator says it has submitted its longawaited report on cheap, pareddown medical scheme options to health minister Joe Phaahla.

The Council for Medical Schemes (CMS) has since 2015 overseen the development of a low-cost benefit option (LCBO) framework that will allow schemes to offer cheap primary healthcare cover. This requires exempting schemes from Medical Schemes Act requirements that they must provide cover for a much broader range of services, known as prescribed minimum benefits.

The report may have farreaching implications for the medical schemes sector as millions of people who cannot afford medical scheme membership could benefit from LCBO products.

Medical scheme membership has hovered around the 9million mark for more than a decade, leaving a steadily increasing majority to depend on underresourced state hospitals and clinics. The poor state of public healthcare has been described in harrowing detail in several high-profile probes.

The CMS briefed the minister on Wednesday, and handed over its report with its “various options and recommendations”.

The CMS declined to release the document, saying it is the minister’s prerogative. His spokesperson, Doctor Tshwale, said the minister needs time to read the report and consider its recommendations, and will then release it.

The Board of Healthcare Funders (BHF) said the minister is required to provide it with the report in line with a recent high court settlement. An association for medical schemes and administrators the BHF has been an outspoken critic of the pace at which the CMS has developed the LCBO framework.

In July it obtained a high court order compelling the minister and the CMS to provide it with all their records on LCBOs; the minister agreed, the CMS is challenging the ruling.

BHF head of research Charlton Murove said the potential market for LCBO products ranges from 6-million to 15-million people. He questioned the CMS’s decision to place the ball in the health minister’s court, saying the regulator has the authority to grant exemptions to the Medical Schemes Act and allow schemes to offer LCBO products right away.

Wits governance professor Alex van den Heever said: “The CMS is not an independent regulator and therefore has little interest in attempting to achieve the goals of the act.”