One of South Africa’s largest medical aid administrators, Medscheme, has welcomed proposals for restructuring the public service’s medical-aid schemes.
A proposed new public-service medical-aid scheme would bring a welcome one million new medical-aid patients into the industry, boosting the insured lives in the private healthcare sector to eight million, Medscheme group services MD Gary Taylor said on Wednesday.
”The new scheme should be an exciting stimulus for growth in an industry which needs new members. This growth comes from the 400 000 state-employed families who do not currently enjoy cover in the private sector,” he said.
The impact of the new patients would be a boost for general practitioners, pharmacies, and all private-sector health care providers.
”In addition, Medscheme and the other administrators will probably all tender for the administration and managed care contracts which will flow from this scheme.
”Of course, this is also a huge challenge for the private sector to do things smarter and more cost-effectively. In addition, it creates new opportunities for public-private sector partnerships. Clearly, this will have a direct impact on black economic empowerment initiatives within the sector.”
While the medical aids that housed public-sector employees would lose these members, it would probably lead to further consolidation of those schemes into fewer but bigger risk pools, ”which is not a bad thing”.
”The Risk Equalisation Fund planned for 2005 will ensure that these medical aids are not prejudiced if they lose good risk members to the state fund,” Taylor said.
”The new scheme will have a number of advantages for state employees, who will now be able to design benefit structures appropriate to their needs and charge premiums at levels affordable for their membership. As this fund will be twice the size of the biggest medical aid in South Africa, it should be able to sustain several benefit plans, thereby suiting the needs of both the highly paid and the previously uncovered.”
On Tuesday, Department of Public Service and Administration labour relations senior manager Kenny Govender told the National Assembly’s public service and administration committee that about 50% — about 400 000 — of the department’s employees are not on medical aid schemes.
These are mainly in the lower-income brackets, while those public servants on medical aid are divided among 61 different schemes.
Consultants have suggested, among other things, concentrating employees in a smaller number of schemes, a single public service scheme, and compulsory cover for all employees.
The latest research findings propose a restricted membership medical scheme for the public service, but no decisions have yet been made.
Further research is now being undertaken to develop, cost, and test the various proposals made, Govender said. — Sapa