CMS role in NHI system unknown

Pretoria - The role of the Council for Medical Schemes (CMS) in the proposed National Health Insurance system was not known, acting CEO Patrick Matshidze said on Wednesday.

Releasing the annual CMS report in Pretoria, Matshidze said the council was yet to receive the actual proposal from the department of health outlining details of its involvement.

"We are aware that there is a proposal for a major overhaul of the entire healthcare system. The two systems (public and private) have to merge into one.

"It would be premature to make any kind of announcement ... as to what role the council will play."

Job losses

Matshidze said the council would, however, should government require it, be able to provide technical expertise.

"Job losses, it is something that we are mindful of," he said, adding that the council would not elaborate as it may adversely affect employees.

A white paper on the NHI is expected to be presented to Parliament early next year.

Commenting on the report, Matshidze said that while there were fewer medical aids operating in the market, membership had remained on the increase. This however improved risk.

Employment medical scheme

He said the effects of the government employment medical scheme, which was incorporating many open medical scheme members, would still need to be determined.

The report showed that amalgamations and liquidations were more pronounced in restricted schemes operated by employers.

Matshidze said some schemes were subsidising contributions from reserves to minimise the impact of contribution increases on members.

He said while membership had increased there had been a greater decline in utilisation. He added that the decline would need further investigation to determine the cause.

Of particular concern was the presence of unscrupulous medical aid brokers who were rendering "non-value" services, Matshidze said.

- Sapa