BHF proposes Pricing Negotiating Forum for healthcare industry

The body has advised members of medical schemes that the solvency level of a medical scheme does not necessarily have an adverse impact on the schemes' ability to pay its claims.

The BHF does not support the current 'one size fits all' solvency legislation and believes that the current methodology should be reviewed. It further believes that the current solvency requirement is not practical in the current environment and suggests that an alternative model, similar to that in the short-term insurance sector, should be considered. Should this occur, medical scheme contribution increases could be reduced.

The decreasing of reserves held by medical schemes is an indication of the pressure to maintain affordable member contributions in the face of spiralling healthcare costs, says the BHF.

BHF proposes Pricing Negotiating Forum

It is to this end that the BHF is urging government to establish the proposed Pricing Negotiating Forum so that the tariffs which are paid are fair and reasonable both to the provider and the medical scheme member.

The BHF is also calling on government to fulfil its mandate to perform a revision of the PMB regulation as it relates to affordability and consistency with health policy developments. It believes that this revision, which should be performed every two years, but which government has never performed, would act as a protection measure for medical schemes and their members against spiralling costs and discriminatory legislation.

Dr Humphrey Zokufa, MD of BHF says, "Medical schemes, through their members are responsible for a R90 billion private healthcare industry. But due to the lack of formal tariffs and the structure of the PMBs, members are being disadvantaged. The fee for service model and potential perversities, creates an unhealthy environment, wherein medical schemes are compromised in ensuring that membership money is spent judiciously."