Medical schemes sceptical about NHI

2012-07-03 15:01

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 reveals.

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.

Participants 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 expenditure.

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.”


  • paulo.teixeira.39948 - 2012-07-03 15:22

    I myself can't see how it would work with the current administration, even though it's sorely needed.

      hans.himmler.7 - 2012-07-03 15:34

      Hang on Paulo. 1994 ANC stated free health care for all. What happened to this deliverable? Due to corruption etc. its now being passed to the tax payer and private medical sector, because the ANC caused a mass exodus of skill doctors, screwed up the universities, and ran the "well oiled" apartheid hospitals into post apocalyps structures. I can agree that private medical rates need to get a health check, but nationalizing healthcare in ANC run SA is a bad idea.

      susanna.smit.7 - 2012-07-05 15:24

      Mandela is frail. Does he have a private doctor or does he visit the government clinic in Khunu?

  • Deon - 2012-07-03 15:32

    It might work with the help of private Drs and private hospitals as up to 70% of Drs work in the private sector.

      alan.gernet - 2012-07-03 15:41

      @Hans - meaning???

      hans.himmler.7 - 2012-07-03 15:45

      Alan, at what cost to you and I "might" the NHI work with Drs from private hospitals. How different is this "idea" from the SANRAL debacle. Am I completely missing the point, or has the time come for me to consider emigration?

      alan.gernet - 2012-07-03 15:49

      Well - the Govt will have to pay the doctors, and they are not going to work in the NHI for peanuts. Why should they? They studied hard to get where they are. Plenty of opportunities for Doctors elsewhere in the world, so it would just mean a further Brain Drain for SA. Few real doctors would put up with NHI if forced to do so by the Muppets.

      hans.himmler.7 - 2012-07-03 15:56

      Alan, it was slight what a rhetorical question, but great to have your opinion, and I agree 100% Also, it would probably be a shift, i.e. the current hospitals will become defacto government end points, and medical schemes would probably build new hospitals for the 100% private sector. Can you imagine the costs. The ANC is just proving once again that they and their followers are like leaches. Almost 20 years later the ANC are still bread eaters, or thieves, instead of bread bakers.

      alan.gernet - 2012-07-03 16:02

      Yip Hans - that's it in a nutshell. Teach a man to fish .. and he will have food. Give him food, and he is happy for a day. The ANC needs to slow the population explosion (Not Zoomer Style), save the environment, and educate the population. Otherwise - there is no long term fix for SA.

  • trevor.pietersen.3 - 2012-07-03 15:41

    What ever THEY try...DOESN"T work

  • Ze Don - 2012-07-03 15:42

    Medical aid schemes will take a HUGE hit if NHI ever happens. I know I for one can't afford to pay both!

      hans.himmler.7 - 2012-07-03 15:49

      Exactly, so what will follow? The quality of health care that you, I and our children will / can receive in SA. The ANC will screw thus up in the end too. Did our roads have potholes in the old SA?

  • rohan.coetzee - 2012-07-03 15:51

    I recently found myself in Gov. hospital and was pleasantly surprised with the excellent treatment I received. Was very sceptical after always having medical aid till recently. Yea lots of waiting but to be expected. Well done Polokwane!!

      alan.gernet - 2012-07-03 15:59

      You are one of very few, and it is good to hear of your experience. I have a lady who goes to PTA Acedemic to receive her monthly chronic drugs. One month, the doctors are on strike, and the next,the nurses have shut up shop at 10am to have a tea-party for the rest of the day and turn patients away. 7 Months is how long it took to get her blood tests after being lost twice. Otherwise - the medicines have run out, so she has to go without and come back a month later. This is just what some OUTPATIENTS experience - Admitted patients face more horrors that their own ailments in Govt. Hospitals in many cases. Sorry - but without Professional Administration and vast resources, the Govt cannot provide quality care. Problem is that they will never be able to afford it, so we will just be yet another African failure.

      hans.himmler.7 - 2012-07-03 16:14

      So here is an excellent example. My grand dad had to go for a hip replacement, no medical aid. By hook and by crook we bypassed the USSR red tape bs, and got him admitted at JHB Gen. He was operated, by I don't really want to know, and managed to return home safely and with a new hip joint. His room at JHB Gen however, he had to share with let's just say less desirables, and there was blood on his linen, and linen stuffed in the corner of the room filled with urine and ... Two years later he had blood circulation problems, and eventually he had to get his legs amputated. Government hospitals could not diagnose him, neither wanted to help him. It all depends what you get treated for. Most probably in your case, the local clinic would've been able to assist you. I think, without being obtuse, the saying "You are in God's Hands" rings so true if you do find yourself in a government hospital.

      sarel.koen - 2012-07-03 16:52

      @Rohan You were one of the lucky few. One of my patients had to wait 6 days for surgery after she fractured her knee. She was put on a drip and only had 2 cups of tea per day, waiting for her op....

  • Ian - 2012-07-03 15:56

    If they implement this what happens when I need medical care, no freaking way I'm sharing a ward with Mr Criminal, Will just up my premium to the top and pay for private ward, end of story

      alan.gernet - 2012-07-03 16:08

      Yeah - and it's not like our Govt. ever uses State Facilities when they get sick! One cough, and off to the Private Docs and Hosp's they go.... Even neigbour Bob does that .. it's the African way. Fool the people with rhetoric and blame, and ignore all that when it suits you.

  • danny.levin.351 - 2012-07-03 16:05

    As long the the ANC are trying to run it, not the NHI nor anything else is going to work. you cannot run anything by appointing inept and corrupt cadres who are there only to stick their fingers in the cookie jar. what's more, when they are caught they are protected. This will be just another way to milk the tax-payer even further.

  • Thanduxolo Galada - 2012-07-03 16:12

    Off course they're skeptical, medical schemes want to contain costs while increasing premiums! They've profited for far too long these fat cats. If they're so concerned let them contribute their skills to scale what works well in private hospitals in the public sector. Most of the flickering lightbulbs that comment here have narrow, knee jerk reactions always ready to critique government. You've not once commended Dr Aaron Motsoaledi for sound leadership in SA health-care. Remember it is your fore-fathers that created an unequal playing field!

      alan.gernet - 2012-07-03 16:26

      What a load of utter cr*p Thandu.... Nobody is entitled to anything unless they work for it. The medical aids are not compulsory for most. If you want an education in SA - you work hard and you pay for it. If you want proper medical facilities - you pay for them. As the Govt. continues to squeeze the life out of the taxpayers (where 1 taxpayer is supporting 8+ non-payers), the Govt. is killing their only remaining goose that lays the golden eggs. Get over the "I want, I deserve" .. and do something positive about it for yourself. It all starts with your own attitude and work ethic!! And while you are at it, don't forget to thank God that you still have some opportunities left in SA. Because soon, we will be the next Begging Bowl in Africa.

      Hadebe - 2012-07-03 16:41

      Alan shame, wht are rumblin abt? Can u rephrase please!

      hans.himmler.7 - 2012-07-03 16:42

      Well said Alan, quite probably understood as Greek.

      alansmartSnr - 2012-07-03 21:51

      ..@ Thanduxolo Galada..You must be on some serious medication or something terribly intoxicating. Quoting:"You've not once commended Dr Aaron Motsoaledi for sound leadership in SA health-care." He closed all the nursing training schools. WHY?.. Me thinks that you dont have the foggiest idea of what is going on in the public hospitals. We had a brief spurt of improvement when we had those Cuban docters here but since they left ('cause of the incompetance of the "new" type of nursing staff) our medical system has gone down the drain. Eat beetroot for aids, Babies dying by the score for lack of supervision..too many mess-ups to list. Surfice to say that even our many clinics (I acknowled one good thing") are not functioning smoothly and hardly ever have the required medication" I could go on and on but will just go to the bottom line. This hero of yours screwed up our health care system and it's going to take many years or some drastic intervention to provide even the basic medical care which you and I might need some day

  • sarel.koen - 2012-07-03 16:32

    Medical aids are sceptical, but we as medical doctors are downright negative. When NHI comes in, expect an additional 7-10% tax from your salary and expect even more doctors to emigrate.

  • jacques.vandermerwe.140 - 2012-07-03 16:41

    The only way this will work is if every adult person in the country is taxed a fixed rate (say 5% of income) that goes into a big NHI pot, for funding basic health care. This way, everybody pays and everybody gets basic care. What will not work is taxing wealthy individuals only (those who already have private insurance) and give the rest a free ride ~ e.g.the toll road model, everybody pays except heavy users like taxi's. Somehow I think this is whta the ANC will do, which will collapse the system before it even gets going.

  • Essy1945 - 2012-07-03 17:00

    They can't even provide basic needs, a 2.2 billion is spent on an aeroplane SICK - how on earth do they think they'll manage a national health system? I most certainly will resign from my medical aid (bye Discovery - which I pay in excess of R4500 p.m. with dependants), and I will most certainly become one of the "grant users and NHI dependants" and will no longer be a tax paying fool for much longer... Why should I when I too can get it free! After all, I'm preparing to be out of work from January onwards so.... yeap FREE for all!

  • martin.gee.godfrey - 2012-07-03 17:16

    Imagine how the 2 billion rand that was to be sent on a plane for the Prez, and the 15 billion we gave to the IMF could have improved the curent health-care situatin in this country! It is still all tax-payers money but at least it would have been better spent!

  • freddy.vanwijk - 2012-07-03 18:47

    If ever the NHI scheme is successful, how would this affect employees that do have something already in place? I would not accept NHI if I have already something in place. Then how would NHI be financed? Answer is not by taxpayers but by other sources.

  • raul.curado.1 - 2012-07-03 22:31

    Who would not be sceptical about any government move? They f#X* up everything they touch. Only Midas could change things into gold. Conclusion: we need a Midas!

  • michael.kleber.376 - 2012-07-04 07:40

    the tax base is too small can't have 3 million tax payers supporting 50 million people , i for one would love to have the NHI work as medical aid is sky high but have yet to see anything the ANC lead govt take on work , they seem to have the midas touch , everything they touch turns to sh,one,t

  • Lydia Benkenstein - 2013-07-03 21:50

    Before anything else, keep these public hospitals clean. Then train all medical staff on how to talk to patients. Do not say "what" when a patient asks a question.

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