HMI recommendations will contribute to universal coverage

Lerato Mosiah, CEO of the Health Funders Association

“These recommendations introduce mechanisms for progressive and positive changes to occur in the private healthcare market, such as moving towards alternative reimbursement systems and away from the traditional fee for service system, which has led to perverse incentives," Lerato Mosiah, CEO of Health Funders Association (HFA), says.

The recommendation for maximum tariffs for Prescribed Minimum Benefits (PMBs) is positive. However, Mosiah believes that in order to achieve this, funders and providers should come together to work on an industry wide single set of billing codes before the Supply Side Regulator for Healthcare is established, as suggested by the HMI. Clarifying the definitions of PMBs will also assist with this.

The HFA agrees with the recommendation for an industry-level role for health technology assessment and believes that this will assist the entire industry to make funding decisions based on the quality and efficacy of new technology entering the market, such as biological medicines and new equipment. This competency will also improve the health system’s capacity to assist patients with rare diseases.

“Most other health systems in the world rely on a central entity for health technology assessment in order to provide guidance in benefit design and funding decisions. In South Africa, each medical scheme has been left to do this work on their own for their own members. This is not only a duplication of work but also a waste of funds”, she said.

The association welcomes the proposed mechanisms to introduce greater transparency for members of medical schemes, such as a standardised benefit option and comparable top-up cover, as these will empower members to make more informed decisions about their healthcare.

The HMI also emphasises the importance of a well-functioning medical schemes market in healthcare provision. The recommendation for the creation of a risk adjustment mechanism may contribute in this regard and would close some of the gaps in the incomplete private healthcare sector regulatory regime.

“The recommendations will bring about more cohesive and efficient private and public healthcare sectors that will improve the quality of care experienced by patients," concludes Mosiah.