Evolving Health Provision in South Africa

Most South Africans have at least some knowledge of the proposed National Health Insurance (NHI) scheme. Just how it is going to protect us when it comes to health delivery is a little murky at present, although planning and political posturing is in progress. How it will affect each one of us after roll-out remains a mystery for now.

Private vs. State

The reality is that the matter of private versus state medical cover remains cloaked in secrecy as we approach the 2014 General Elections. Commissions have been set up to investigate the kind of costs, and the types of cover we can all expect in the not too distant future. Government despises the enormous gap between first world private medical schemes, and the third world over-burdened and financially crippling state health system already in place.

Put another way, some see the authorities as deliberately trying to manipulate private health care, in order to make it more affordable and available to the entire population.

Crossroads

That we are at an important crossroad is not in dispute, and that is across all political persuasions. Private-scheme stakeholders are understandably jittery about new regulatory moves to limit their influence and huge profits. The introduction of new regulatory measures is a necessity if we want to control the spiralling costs of decent medical provision.

Moreover, the alarming rate of increase in contributions paid to private medical aids needs curbing. Could there be a win-win scenario for the government to follow? Many believe there can indeed be, and the outcome could be mandatory membership and subsidisation across all income bands to benefit everyone.

The plan could be as simple as relieving the cost burden on existing medical scheme members, and inducing more lower-income earners to join.

Three Tier Model

A three-tier model could follow, and could look something like this:

• Around 17% of the population are already on high-health cover private schemes. These high-income earners would remain on what could become more regulated medical schemes for their health needs.
• Lower-income earners - representing a further 13% of the populous - could join specially designed schemes at lower rates of contribution.
• The balance of the population would remain on a better-run-and-financed public healthcare system. This model could receive its funding from NHI contributions taken from all working people, and boosted by injections from the national budget.

A Welcome Change

As one of the lucky 17% presently enjoying private medical cover, I would welcome a fresh and new approach, and the protection a decent National Health Insurance programme could offer. Over the last 10 years, I have received an average annual increase of 15% to the cost of my contribution, while the benefits have changed markedly too, and rarely for the better. The recent introduction of co-payments is another way schemes are lessening their risk and maximising profit.

To my thinking, this means that fund operators are making obscene profits out of their membership base as well as from the healthcare service providers. Alas, there is little you can do about it except opt for a lesser scheme once a year at about this time. Tariff regulation is one way forward and at age 60-plus, I would welcome such a move.

Before you shoot the messenger, please remember that I have contributed regularly to various medical funds over 40-years and more of work. My claims record would put most professional healthcare providers out of work, because fortunately, I have enjoyed excellent health. Since I am approaching pension age, I believe I have earned the right to some subsidisation from healthy and younger members. Surely, this is one of the core objectives of any good medical health programme.

Over the years, I have become quite adept at understanding precisely what my medical scheme offers me in return for my set monthly premium. Let me shed some light:

• Read and digest your scheme rules thoroughly each year. Clarify any matters you do not understand and always obtain authorisation ahead of treatment.
• Be aware of the terminology they use; ask if you do know what it means. Good schemes provide a glossary of terms.
• Stick to in-hospital schemes rather than a fully inclusive medical plans and save hugely on contributions.
• Review the options, benefits and costs applying to your scheme every year, because they do change, sometimes dramatically.
• Try to join an option with a medical savings fund – this covers the day-to-day expenses of visits to the doctor, dentist and other healthcare providers.
• If you need expensive treatment, negotiate the cost with your healthcare provider upfront and make sure your medical scheme will cover 100% of the costs. The last thing you need is a shock from the billing whilst in post-operative care.
• Treat your medical scheme as you would your bank account, and avoid going into overdraft! Emergencies are normally fully covered.
• Avoid unnecessary visits to your healthcare providers – ultimately you will be paying for it.

Last word: considering that a country as rich and powerful as the USA does not have free and fair medical cover for most of its people yet, we in South Africa should be proud and grateful that we are a lot more advanced in the important area of healthcare provision. It can only improve for the better!

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