MedicalBrief 283 - 12 December 2019
"The Council for Medical Schemes has stunned the private health care sector with its decision to scrap by March 2021 the pared-down schemes and primary health-care products used by low-income families, writes MedicalBrief. Providers warn that the move is unconstitutional and with potentially catastrophic consequences.
The CMS’s move has also caught the Treasury on the back foot, with sources saying it was not aware of the plan. Without an alternative, the demise of these products could leave hundreds of thousands of families without access to private health care.
The CMS move is at odds with the Constitution and will have potentially ‘catastrophic consequences’ for consumers, says Day 1 Health CEO Richard Blackman, in a Business Day report.
Another Business Day report says the move will not only affect consumers but also throw a spanner in the works for medical schemes and insurers that have been developing cheap products aimed at low-income workers. Many of these products are subsidised by employers and, at a few hundred rand a month, cost a fraction of traditional medical-scheme cover. While the CMS aid it was developing a new and more affordable prescribed minimum benefit package with a strong emphasis on primary health care, the package has yet to be costed. Industry sources are sceptical that it will be in place by the 2021 deadline.
CMS registrar Sipho Kabane issued the circular on 4 December, saying no low-cost benefit options would be permitted going forward, and no more products based on exemptions to the Medical Schemes Act would be allowed after March 2021. The exemption framework had created opportunities for companies to offer products that were not in consumers’ best interests, Kabane is quoted in the report as saying. “Our major concern is that they over-promise and under-deliver,” he said."
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