What NHI means for your medical aid

MAYA FISHER-FRENCH: GETTING PERSONAL - Aug 14 2009 06:00

Not much has been said at this stage about the National Health Insurance (NHI) -- so all discussions are mostly hypothetical.

What we do know is that a proposed national health fund will be created using 3% to 5% of payroll. It is not clear at this stage what contribution employers and employees will make.

The fund would cover basic medical needs and a doctor would need to be accredited with the NHI to be paid for his or her services. This has left the question of what will happen to medical schemes and what services citizens could still acquire privately.

The Board of Healthcare Funders (BHF) has put forward a proposal that would see medical schemes forming part of the NHI. South Africa’s medical schemes already administer healthcare on behalf of seven million people and have administration agreements with most private-sector doctors.

Under thi s model , medical schemes and their administrators will collect contributions for NHI benefits from the NHI agency and pay these across to the members by supplementing their monthly premiums.

The schemes would then offer the benefits provided by the NHI but will also provide top-up cover for shortfalls between the benefits members receive and what the NHI will cover.

According to the BHF, constitutionally government cannot deny the public access to private healthcare that it already enjoys. As the payroll deduction will cover NHI benefits, scheme members will pay a lower premium for the top-up benefits.

Members can opt out of their medical scheme at any time should they be confident about relying purely on NHI services.

Benefits
Benefits to members:

They can continue as normal with medical bills administered through the medical scheme;

They can continue to access private facilities that remain of a higher standard than public facilities;

They can continue to access all the medical services covered by the existing medical scheme; and

They can opt out of the medical scheme at any time.

Benefits to medical schemes:
They continue to exist. As the schemes become more affordable because of the lower premiums, it is possible that medical scheme membership would actually increase under this proposal.

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Benefit to government:
Government can leverage off the existing infrastructure of the schemes’ administration systems. It can also tap into the claims and cost-management experience of large schemes.

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What NHI means for your medical aid

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