The following Healthcare Newsletter was issued by ACA Employee Benefits - 2019
The publication of the final report of the Health Market Inquiry (HMI) has been postponed due to budgetary constraints. The HMI has apparently cost R197 million to date. The HMI process has consequently been suspended until 31 March 2019 and activities only resumed after this date. The date for the publication of the final report has now been moved to September 2019. In the meantime the submissions of the organisations that made submissions in respect of the provisional report have been published on the HMI website.
The Review of the Prescribed Minimum Benefit (PMB) package as part of the reform leading to NHI is also ongoing. Five committees have been established in 2017 and have been working on a draft PMB benefit package. To date only a broad framework for the new package, which will be aligned with the offering of the public sector in anticipation of the introduction of NHI, has been released for comment. Stakeholders have also been engaged by the Pricing Sub-Committee to explore a suitable pricing methodology for the new package. The costing exercise aims to establish valid current and projected costs of the envisaged revised PMB package.
The focus of the proposed package has moved from being disease/diagnosis/condition-based to a services-based package, which will in all likelihood also include primary care services. Hopefully, this will result in a less complicated package for beneficiaries and lower costs to schemes. The cost of the PMB package has increased from R457 per beneficiary per month in 2006 to R746 per beneficiary per month in 2017, due to increased utilisation stemming from increased awareness by beneficiaries about PMB’s as well as the ageing of the medical scheme population.
The deadline for comments on the Medical Schemes Amendment Bill and the NHI Bill was in September 2018. Subsequently, NHI has become a presidential priority and it was revealed that a new NHI Bill has been prepared and submitted to Cabinet. This Bill has not been released into the public domain to date. This might only happen after the elections. In addition, it is not clear where the process is in respect of the Medical Schemes Amendment Bill. It is, however, expected that this Bill will also be introduced in parliament only after the elections. Should amendments be made to this Bill in the light of the recommendations made by the HMI relevant to schemes, it is hoped that stakeholders will be granted another opportunity to comment before the Bill is submitted to parliament, after which the parliamentary process to legislate it will commence.