The Board of Healthcare Funders (BHF) will go to court in efforts to legally compel the Council for Medical Schemes (CMS) to allow cheaper medical aid plans.
The BHF, which represents more than 40 medical schemes, will seek a court ruling that compels the CMS to allow schemes to offer low-cost benefit options or LCBOs.
BusinessTech reports that the fight has been going on for a decade.
The CMS passed a resolution in August 2015 to adopt a framework for LCBOs offered by medical schemes, but the policy was not implemented due to lack of support from the National Department of Health.
This was because “they were not comprehensive and did not account for national coverage priorities such as HIV and other diseases”, the CMS said at the time.
The CMS noted in 2022 that it was still developing and formulating the guidelines on LCBOs, and by 2023, this process was still ongoing.
However, during this time, medical schemes represented by the BHF grew frustrated and took the CMS to court, accusing it of purposely delaying implementation because of the government’s favoured National Health Insurance (NHI) scheme.
The BHF launched court action against the CMS in 2022 to try to force it to lift what it called a “moratorium” on the LCBO process and compel it to grant exemptions to medical schemes wanting to offer the plans.
This went through various legal proceedings, ending with the CMS guidelines being finalised and sent to the NDoH for approval in November 2023.
In April 2024, the exception period for medical schemes to offer the plans was extended for another year, as nothing had been done by the NDoH.
A month later, the NHI Act was signed into law.
Next big fight
On Tuesday, the BHF again headed to the courts, noting that in the CMS and NDoH’s responding affidavits, they cited the delay in implementing LCBOs as being due to the NHI roll-out.
Ironically, this represents a massive impediment to low-cost healthcare, with the NHI Act not yet being promulgated, and the scheme not envisioned to be up and running for years, if not decades, from now.
The BHF highlighted this in its application.
“The BHF strongly believes healthcare is not a future need…Millions of South Africans require solutions today, not years from now,” it said.
The board added that the NDoH’s own timelines shows that NHI will only be fully implemented from 2028. However, this is likely to take much longer. The NHI’s own developers have admitted it will take decades to turn a corner on South Africa’s healthcare landscape, and the government is preparing for a legal onslaught.
Meanwhile, LCBOs can be implemented immediately, the BHF said.
“With the stroke of a pen, the CMS could enable more than 10m low-income earners access to essential primary private healthcare services without the state having to cover the costs.”
No compromise NHI
The delays in implementing any healthcare policy that might involve the private sector should come as no surprise, given that the NHI Act intends to do the opposite.
It is not in the government’s interest to promote lower-cost private medical aids when it intends to effectively remove medical aids from the picture under the NHI.
According to section 33 of the NHI Act, once the NHI is “fully implemented,” medical aids will not be able to provide cover for services paid for by the state fund.
It is currently unknown what the government considers “fully implemented”, what the NHI will actually cover, or when the provisions under this section will come into effect.
Despite the unknowns, Health Minister Aaron Motsoaledi has been adamant and uncompromising on this section being in the laws.
Speaking to Bhekisisa in 2024, Motsoaledi said that if alternative proposals are put to the government that do not involve reforming financing, it would be a “waste of time.”
Motsoaledi said section 33 was crucial to the NHI, and removing it would be akin to building a house without a foundation: it would simply collapse.
The BHF said it was trying and willing to collaborate with the government on a solution and a move towards universal healthcare.
Offering LCBO is a “practical solution that could immediately put our country on the path towards achieving this goal”.
Business Tech article – Big fight for medical aids in South Africa (Open access)
See more from MedicalBrief archives:
Low-cost schemes will soften NHI tax burden, argue medical schemes
Medical schemes appeal CMS scrapping of low-cost benefit packages