Millions of South Africans stand to gain from proposals aimed at extending the benefits of medical aid schemes, Health Minister Manto Tshabalala-Msimang said on Monday.
”What we seek to do is ensure that there is equity and fairness in the health care system in South Africa,” Tshabalala-Msimang said.
She was opening an international review panel workshop, which will, until Friday, debate and make recommendations on establishing a Risk Equalisation Fund as part of reforming the country’s private health care system.
”Access and funding of essential health care for every citizen was and still is a high priority in our transformation agenda,” said Tshabalala-Msimang, stressing that post-1994, the private sector has accounted for more than 60% of total health expenditure while providing care for less than 20% of the population.
Acknowledging that the private sector faces a number of challenges — such as costs increasing faster than the inflation rate, rendering it unaffordable to many — the health minister said the government has taken initiatives to improve access to health care by, for example, introducing the Medical Schemes Act in 1998.
”With the Medical Schemes Act firmly entrenched in our private health care industry, we feel more ready to press forward with the rest of the reforms. We have taken the policy position to move to establish a social heath care insurance system in our country,” said Tshabalala-Msimang.
She said the social health care insurance system will comprise three components — risk-related cross subsidies, income-related cross subsidies and mandatory cover.
The government has established two task teams, one looking at developing a revised subsidy framework for medical schemes, and the other to develop a risk equalisation fund formula.
”Of key concern to us is how we can effect both risk-related cross and income-related cross subsidies in the medical schemes market, especially as we move towards a social health insurance system … Our challenge is one of timing and sequencing, while also ensuring that we have the technical capacity both in terms of information and institutions to successfully implement a Risk Equalisation Fund,” she said.
Professor Heather McLeod, chairperson of the Risk Equalisation Fund consultative task team, said that currently the prescribed minimum benefits of medical schemes require 270 diagnoses to be treated, and another 25 chronic disorders.
McLeod said costs increase dramatically as one grows older, with the result that schemes try to attract people with a younger profile.
”For the medical aid package, if the average is R200, some people are paying R120 while others are paying R800, just because of age differences. This is neither fair nor equitable, and the proposal now is to put the risk equalisation fund in place so that young schemes have to put a bit into the fund, and older schemes can take out of the fund in order to have one common rate of R200 per person per month,” she said. — Sapa