Overseeing the wellbeing of medical aids

With healthcare costs spiralling out of control, uncertainty about the National Health Insurance (NHI) scheme, and a decline in employer subsidies for members, the prognosis for South Africa’s 110 medical aid schemes and their 8.1-million beneficiaries hardly seems a picture of health.

Adding to the woes of a threatened industry is the disturbing fact stated in the Council of Medical Schemes’s annual report of 2010 that medical aid schemes paid out R2.5-billion in claims in excess of the amount ­collected in contributions.

Adding to the pressure the industry is facing is that since 2000 34 medical schemes have ceased to exist. It is doubtful that our private healthcare has ever known such a period of insecurity. But guiding the industry in these uncertain times is Dr Monwabisi Gantsho, the chief executive and registrar of the Council of Medical Schemes.

It has to be the toughest job in the private healthcare sector, but Gantsho, who has been at the helm of the council since June 1 2010, is eminently qualified for it. He graduated in medicine from the University of KwaZulu-Natal, also has an MPhil in economics and political science and has received a postgraduate fellowship in leadership and management from the University of Cape Town’s graduate school of business. He also spent time at Hampden-Sydney College in the United States as an international visiting scholar, teaching health economics and conducting research into universal access to healthcare.

Gantsho has worked as a medical practitioner, starting his career as a medical officer at Livingstone Hospital in Port Elizabeth in the 1980s and later working as a general practitioner in Motherwell.

Finding his niche in medical politics, he served as executive chairman of Eastern Cape Medical Business Systems and the Eastern Cape Independent Practitioner’s Association. He was also appointed a city councillor in Port Elizabeth and served in that role for two years.

In 2005 Gantsho was made head of the private practice and economics research unit at the South African Medical Association, a body representing doctors and other medical professionals. He is also deputy chairman of the medical tourism steering committee at the department of tourism and a member of the quality improvement and accreditation subcommittee on the NHI.

But it is Gantsho’s current role that will undoubtedly prove to be the most challenging. Set up to protect the interests of South Africa’s eight million beneficiaries of medical aids, the council scrutinises the financial soundness of each scheme, ensuring that the required solvency ratio — 25% of members’ contributions — is set aside as cash reserves, as stipulated by the Medical Scheme’s Act. The council also assists schemes with corporate governance and offers guidance on service.

It has the power to take action against an errant scheme in several ways. For example, the council can appoint a compliance officer to oversee the running of the organisation. If necessary, it can appoint a curator. The council also has the power to liquidate a scheme, to deregister an entity providing services to a scheme, or to place a scheme under judicial management.

The challenges to the future of the private healthcare industry are immense and the stakes extremely high. In 2010 the contributions made by members to medical schemes — although representing only 16% of the population — still totalled R84.9-billion. And even though Gantsho’s primary task is to protect their interests, it cannot be done in isolation. The council has to work with all stakeholders to ensure that the healthcare sector is able to complement national health policy that cares for the remaining 42-million South Africans.

Undoubtedly a tough balancing act.

Dr Monwabisi Gantsho is the guest on Bonitas House Call on December 10 at 9am on SABC2

This article originally appeared in the Mail & Guardian newspaper as a sponsored feature

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