CMS orders a stop to prepaid, low-cost GP vouchers

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Barely a week after Discovery Health joined Netcare in selling a novel prepaid voucher product for GP consultations, the medical aid regulator, the Council for Medical Schemes, has ordered them to stop.

The vouchers, costing R300-R350 and launched this year, were a way to make access to private doctors more affordable for people, including those who do not have medical aid. They could also be shared, enabling an employer to provide payment for an employee to see a private doctor.

The CMS said that hospital group Netcare and medical aid administrator Discovery Health are breaching the Medical Schemes Act and behaving like medical aids without applying for approval of their products. It said it had received complaints from members of the public and health professionals about the vouchers.

The Citizen reports that the announcement came after it had approached the CMS and asked whether the new product was not the same as the Discovery Comprehensive PrimaryCare and Discovery Essential PrimaryCare products that had “landed Discovery in hot water before”. Discovery Health and NetcarePlus receive a fee for the facilitation of this service which allows consumers to access healthcare services and in return, they assume liability or risk to ensure that the customer receives the service.

BusinessLive writes that the CMS order could restrict consumer access to affordable private health care for many people who do not have medical aid but are willing to pay towards private care to avoid long queues at clinics. The regulator, however, says if the public had a problem using the vouchers, consumers would have no-one to complain to as the products were neither regulated as medical aids or insurance products that would fall under the Financial Sector Conduct Authority.

Netcare and Discovery said their legal advice was that the products were lawful and did not mimic aspects of medical aids.

Teshlin Akaloo, MD of Netcare’s Innovative Products division, is quoted in BusinessLIVE saying that its aim was to help more South Africans get access to private health care. “We believe that there is a current imperative to increase accessibility and inclusivity of health care. NetcarePlus does not conduct the business of a medical scheme and this is borne out by the salient features of the product. It is our view that the NetcarePlus vouchers fall outside the Medical Schemes Act,” Akaloo said.

In a released statement, Dr Ryan Noach , CEO of Discovery Health, said that Discovery Health has received a directive from the council for Medical Schemes regarding the prepaid product and will respond in due course. “Discovery’s intention in launching discovery Prepaid Health is to offer innovative access to affordable high quality care. To the best of our understanding there is no insurance component to this product. We took steps prior to launching to ensure that the structure is fully compliant with relevant legislation. We will be engaging with the regulator accordingly.”

The Citizen notes that according to a statement issued by Discovery at the beginning of December when the platform was launched, the first offering will be a R300 voucher for a general practitioner (GP), including the medicines dispensed by the doctor. Noach then said Discovery Prepaid Health would broaden access to high quality treatment and medicine. He said Discovery wanted the prepaid vouchers to become as universal as buying prepaid airtime.

The appeals board of the CMS decided last month to uphold the appeal of the Board of Healthcare Funders (BHF) against a decision of the Council for Medical Schemes last year to grant Discovery Life Limited an exemption for primary care products.

The BHF appealed the decision to grant Discovery Life an exemption because it believed it undermined the principles of social solidarity and cross-subsidisation, saying there were no exceptional circumstances justifying the exemption and the exemption was granted for insufficient reasons.

The CMS has ordered the groups to refund consumers who have bought the vouchers. However, Netcare and Discovery Health are appealing against the decision. The regulator told BusinessLIVE that the R350 vouchers were not cheaper than ordinary GP appointments.

In January this year, Fintech Oyi launched a similar prepaid medical card aimed primarily at employers with staff who are not covered by medical aid. The Oyi Medical Card is a savings card for medical spend only, and is supported by a secure payments technology. No mention is made by the CMS in its latest ruling of the Oyi product.

 

Full The Citizen report

 

Full BusinessLIVE report (Subscription Required)

 

See also MedicalBrief Archives:

Discovery Health introduces prepaid vouchers for GP consultations

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