Johannesburg - Medical schemes in SA doubt the success of
government’s ambitious national health insurance (NHI) and believe the
provision of healthcare in the country is deteriorating‚ a recent survey
The survey by professional services firm PwC, titled Strategic and Emerging Issues in the
Medical Scheme Industry‚ shows the schemes
believe the NHI alone is not the solution to SA’s healthcare problems.
Respondents to the survey believed working conditions first
needed to be improved and a total overhaul of basic resources should be
implemented before NHI.
The survey focused on strategic and emerging issues in the
South African medical scheme industry.
The survey was aimed at raising awareness of medical schemes'
views on emerging trends and issues in the industry‚ understanding the
strategic thinking of principal officers in the sector‚ and providing insight
into how the industry may evolve over the next three years.
Principal of the survey‚ PwC’s medical schemes
leader for southern Africa Ilse French‚ said: “The medical scheme industry in SA faces
unique challenges and it is important that it evaluates and adapt to the needs
of the emerging market.”
The survey said only a quarter of the participants agreed
that the introduction of the NHI system would change the current state of
healthcare if it was implemented in accordance with the focus contained in the
NHI Green Paper.
According to the survey‚ more than half of medical schemes
were of the opinion that the recently announced
investigation by SA’s Competition Commission into healthcare costs could
be useful‚ and 38% believed such an investigation was long overdue.
The majority of participants (95%) were of the view that
prescribed minimum benefits (PMBs) paid in full resulted in excessive benefits
being paid by medical schemes to the detriment of members.
believed that because there was no control over what tariff a provider could charge‚
members’ benefits may be at risk due to possible unwarranted‚ uncontrolled
Commenting on the survey‚ Tom Winterboer‚ financial services
leader for southern Africa and Africa at PwC‚ said: “This is just one of
several findings surrounding the medical aid industry contained in PwC’s first
edition of the Strategic and Emerging Issues in the Medical Scheme Industry
survey‚ which was carried out among principal officers of 20 schemes registered
in SA and one from Namibia‚ covering 53% of the South African industry based on
2010 average principal members.”
The survey also shows the importance of information and
communications technology in health management‚ saying: “Schemes cited managing
data and data quality as the major technology weaknesses within the industry.
"Almost half of the schemes have considered the role of
e-health in reducing costs and improving accessibility.”