The Board of Healthcare Funders (BHF) says the Health Minister should face possible jail time for defying a July court order to produce documents related to low-cost medical benefit options.
The BHF was back in court this week, alleging that both the Council for Medical Schemes (CMS) and Minister Joe Phaahla are in contempt for failing to comply with the High Court order for a record explaining the “irrational” and continued blocking of low-cost benefit options. It argued that officials, including Phaahla, should explain why they should not face jail time.
It believes the regulator is blocking low-cost benefit options to make NHI more palatable, and says low-cost medical scheme options would give lower-income earners access to some private care, like GP visits and acute medication, reports Business Day.
It has been more than seven years since the council began to develop a legal framework to enable medical schemes to offer low-cost benefit options that would be exempt from providing the full, costly suite of benefits stipulated by law.
However, the CMS still has not decided how to do this and has allowed a group of health insurers to continue selling primary healthcare cover products that effectively do the same thing, with less supervision and less customer protection.
In July, the BHF asked the court to declare the CMS’ failure to develop and implement a low-cost framework as unreasonable, requesting a record of how decisions against low-cost options were made.
While the CMS provided many pages of publicly available documents, the BHF was not satisfied.
In court papers, BHF lawyer Neil Kirby said that before the July order for documents, only the CMS “participated”, while the Minister “did not oppose”. To date “the documents and information listed in the (order) have still not been produced”.
The CMS indicated it would appeal against the July order but, said Kirby, this went beyond the time limit of the July order. The continued lack of compliance “delays the progression” of the bigger case against the CMS.
The Minister, says Kirby, “has completely ignored the rules and the order … There can be no excuse for his contempt.”
However, in response, CMS attorney Jehiel Thema said the matter was not urgent and was “an abuse of court process”.
Head of health regulations in the Department of Health Anban Pillay filed papers on behalf of the department and the Minister, making similar points as the CMS about the lack of urgency and filing leave to appeal. He said the CMS was an “independent body”, managing affairs independently of the minister.
The Minister has made “no decision regarding low-cost benefit options”, since the CMS itself has not made such a decision, which must be confirmed by him.
In other words, there are no documents the Minister can provide even if he wanted to. He cannot be in contempt since the dispute is between the BHF and CMS.
Meanwhile, the CMS has recommended that monthly premiums not be increased by more than 5% for 2024, the cap intended to cushion members against the harsh effects of rising inflation – and an attempt to keep premiums in line with the Consumer Price Index (CPI).
CMS chairperson Dr Mondli Makiwane said this was “not cast in stone”, but medical aid schemes that intend to exceed the bar will be required to motivate the need for a higher increase, The Citizen reports.
Factors considered by the CMS when determining the cap limit:
• Higher inflation rate
• Volatile domestic currency
• Surging energy prices
• “Overall lacklustre” economic growth
Makiwane said the tariff limit would not affect prescribed member benefits, as these were protected by provisions of the Medical Schemes Act, and no increase in levies is anticipated.
Regarding the regulatory framework for low-cost medical aids, the council is “currently in the final stages of compiling a document of research findings” and recommendations which it would send to the Health Minister by the end of August.
Business Day PressReader article – Medical aid body turns up heat on regulator (Open access)
The Citizen – Medical aids can’t increase fees by more than 5%, decides council
See more from MedicalBrief archives:
Court slaps CMS with deadline to explain low-cost schemes hold-up
CMS faces legal action over low-cost option delays
CMS anger over claim it’s depriving South Africans of basic private healthcare