21 July 2019

Medical schemes regulator revives plan for central database of members

Business Day 17 July 2019 – The Council for Medical Schemes continues with plans for a registry

The medical schemes regulator has revived a controversial plan to establish a central database of scheme members and is once again calling on schemes to provide personal details about their members. It is pushing ahead with its plans for a national beneficiary registry, which it says will ultimately link to a patient registration system that the government plans to establish under National Health Insurance (NHI). For the article click here

Medical schemes and the high cost of late-joiner penalties

Business Times 21 July 2019 - Leave it too long — or take medical aid gap years — and you may pay dearly

One of the most onerous underwriting tools in the hands of medical schemes is the late-joiner penalty, which can be as high as 75% of your medical scheme risk contribution — and may apply for the full duration of your membership. According to a report on the provisional findings of the Competition Commission's health market inquiry released last year, it is not clear to the inquiry — nor is it known to stakeholders — whether current legal provisions against adverse selection (waiting periods and late-joiner penalties) offset the financial implications of anti-selection. Without this knowledge it is difficult to know whether additional steps must be taken to address anti-selection. For the article click here

Mkhize gives first outline of future NHI’s shape

Medical Brief 17 July 2019 - The ‘reorganisation’ of the national Health Department, an ’embryo’ unit to build capacity, and the ‘backbone’ of a national electronic patient record system that will contain the health details of all citizens by February 2020.

Conceding that “it will be impossible to convince the public about the virtues of NHI unless the health infrastructure is rebuilt as a matter of urgent priority”, the minister said a “team of experts in finance and health … infrastructure” has been established “to seek creative financing mechanisms” and “alternative” delivery models. For the article click here

HPCSA challenged on disclosure of clinical information to medical schemes

Medical Brief 17 July 2019 - The Health Professions Council of SA recently released a guide to address the pressure that practitioners regularly face from medical aid schemes.

Athol Gordon and Tarryn Venter of law firm Clyde & Co, writing on the Mondaq site, argue that the legal situation is more complex than the HPCSA claims. “At this stage, on the basis of the regulations, where a medical practitioner has not contracted with a medical scheme and is not a ‘participating health care provider’ in a managed health care plan, it is clear that he or she is not required to provide medical aid schemes with their patients’ clinical records. For the article click here

Bonitas annual results 2018 - Good vital signs

BizCommunity 16 July 2019 - Bonitas Medical Fund (the Scheme) bolstered reserves from R4.0bn in 2017 to R4.13bn in 2018, despite difficult trading conditions.

As at 31 December 2018, the Scheme had 330,993 Principal members with a total of 710,206 beneficiaries. For the article click here

Publication date: 7/21/2019