CMS revives controversial central database of medical scheme members

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The medical schemes regulator has revived a controversial plan to establish a central database of scheme members and is once again calling on schemes to provide personal details about their members, reports Business Day.

The idea of a central database was first flighted by the Council for Medical Schemes (CMS) in 2017 and ran into immediate opposition from the Democratic Alliance (DA) and several schemes, who expressed concerns about what the data would be used for, and the potential infringement on members’ privacy.

The CMS is a statutory body charged with overseeing the R180bn medical schemes industry, which provides cover to about 8.9m people. The report says it is pushing ahead with its plans for a national beneficiary registry, which it says will ultimately link to a patient registration system that the government plans to establish under National Health Insurance (NHI).

It is expanding a pilot programme that began several months ago with South Africa’s biggest medical scheme for civil servants, the Government Employees Medical Scheme (GEMS).

The report says in a circular issued on 9 July, the CMS called on other schemes to register for the pilot programme by end-August. It wants schemes to start by providing data on 10,000 members, and once the initial kinks have been ironed out, transfer a second tranche of information on the rest of their membership base by end-February. CMS spokesperson Grace Khoza said the regulator is taking “the best possible” measures to protect members’ privacy and ensure their information does not end up in the wrong hands.

CMS chief information officer Jaap Kugel said in the report that the data required of schemes is “very limited” and will not include any clinical details.

Kugel said in the report that the registry will enable state facilities to check whether patients belonged to a medical scheme, track the movement of members between schemes, and make it easier for the CMS to communicate with members.

GEMS principal officer Guni Goolab said “very minimal” data from the scheme’s members has been provided to the CMS to date, and none of it is health related. The focus has been on figuring out the technical aspects of feeding data into the CMS system, he said.

The report says the Board of Healthcare Funders, an industry association for medical schemes and administrators, previously expressed reservations about the plan. However, it has yet to formulate a position on the current proposal.

The report says Discovery Health said that it is engaging with its client medical schemes and will engage with the CMS in response to the circular.

 

According to a Business Tech report, the CMS said that this registry – called the National Beneficiary Registry – will benefit the CMS and the medical schemes industry in the following ways: membership history will be preserved as one Beneficiary ID number will be allocated to a member for life. This Beneficiary ID number is computed using a variable amount of data about the member, thereby creating a unique identifier for each beneficiary; verification of membership status of patients that have medical aid cover, visiting state facilities; demographic reporting which will aid in health planning; improved and direct communication with members; data verification and quality improvement by schemes and administrators; monitoring of membership behaviour over time; and future linkage to the NHI Health Patient Registration System (HPRS).

The circular does not indicate when the new registry will be officially introduced, however, it has called on medical schemes to take part in a pilot programme later this year.

The report says while the circular indicates that the registry will be tied into the NHI Health Patient Registration System at a later date, the government said that it has already begun enrolling South Africans for the incoming National Health Insurance.

Presenting his departmental budget on Friday (12 July), Health Minister Dr Zweli Mkhize said that his department has already enrolled more than 42m South Africans in the Health Patient Registration System. Mkhize said that this system was developed for the implementation of the NHI and will act as a “backbone of an electronic health patient record”.

“We have already registered 42.6m users on the system and all South Africans will be registered by the end of this financial year,” he said.

“We support the Department of Home Affairs in the registration of babies in our hospitals, as they will then be registered automatically on the NHI patient register. NHI will require a digital health platform that will support the operations of the NHI Fund and work has already commenced in this regard.”

The report says while the updated NHI Bill has not been made available for public comment, the Health Department has previously indicated that everyone that can afford to do so will be liable to contribute towards the NHI Fund. These contributions to the NHI Fund would be in addition to any medical aid scheme premiums if individuals should choose to remain members of a private scheme.

Business Day report
CMS circular
Business Tech report


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