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Cape Town - While the government's proposed National Health Insurance (NHI) scheme is expected to have little effect on medical schemes in the short to medium term, the long-term impact could be dramatic, an actuary said on Friday.
Consulting actuary for OMAC Actuaries and Consultants, Jan Howel, warned that should the NHI proposals be implemented in their current form, a situation could develop where "only the very rich will be likely to... afford both the NHI tax and a medical scheme for their families".
He urged schemes and employers to submit comments on the soon-to-be-released green paper on the NHI proposals.
"Should this proposal be implemented in its current form, the role of medical schemes in South Africa could change dramatically in the long term."
The long-term impact depended on affordability of NHI tax and medical schemes' contributions, as well as quality of care in the public sector.
If the NHI proposals were implemented as they now stood, medical schemes would be allowed to continue to operate.
"However, individual medical scheme members will not be permitted to opt out of the NHI. South African citizens will be obligated to contribute to an NHI tax, which will be calculated according to an individual's income.
"As a result, medical schemes are likely to offer members a greater choice with regards to healthcare providers and more convenient timing of procedures, in the hope of enticing members who might not be satisfied with the choices available on the NHI.
"Alternatively, schemes may opt to offer top-up cover or supplementary cover for procedures that are not covered by the NHI," he said.
Further, if the introduction of NHI resulted in adjustment to some of the requirements of the Medical Schemes Act, it was likely schemes would start to offer insurance-type cover.
This would allow them to decline cover for a sick person or, alternatively, charge a premium for people with a higher health risk.
"Under these adjustments, schemes may also be allowed to choose which benefits to cover, as there may be no regulation regarding a minimum set of benefits," Howell said.
