The Health Funders Association (HFA), the representative organisation of most medical schemes and medical scheme administrators in South Africa, welcomes the comprehensive report of the Competition Commission's Health Market Inquiry (HMI) and recommendations contained therein.
Membership of the HFA covers 53 percent of medical scheme members across open and restricted schemes (made up of 76 percent from open schemes and 21 percent of restricted schemes). The membership covers more than 4.4 million medical scheme beneficiaries.
Once implemented, most of the recommendations contained in the report will provide a conducive environment for attaining universal health coverage. These recommendations introduce mechanisms for progressive and positive changes to occur in the private healthcare market, such as moving towards alternative reimbursement systems.
The HFA particularly welcomes measures to improve measurement of quality care outcomes and to structure incentives on this basis.
The recommendation for maximum tariffs for prescribed minimum benefits (PMBs) is also welcomed by the HFA. However, in order to achieve this, funders and providers should come together to work on an industry-wide single set of billing codes before the Supply Side Regulator for Healthcare is established, as suggested by the HMI. Clarifying the definitions of the PMBs will also assist with this.
The HFA supports the recommendation for an industry-level role for health technology assessment and believes that this will assist the entire industry to make funding decisions based on the quality and efficacy of new technology entering the market, such as biological medicines and new equipment. This competency will also improve the health system's capacity to assist with rare diseases.
Most other health systems in the world rely on a central entity for health technology assessment in order to provide guidance in benefit design and funding decisions. In South Africa, each medical scheme has been left to do this work on their own for their own members. This is not only a duplication of work, but also a waste of funds.
The association welcomes the proposed mechanisms to introduce greater transparency for members of medical schemes, such as a standardised benefit option and comparable top-up cover, as these will empower members to make more informed decisions about their healthcare.
The HFA welcomes the view of the HMI on the importance of a well-functioning medical schemes market in healthcare provision. The recommendation for the creation of a risk adjustment mechanism may contribute in this regard and would close some of the gaps in the incomplete private healthcare sector regulatory regime.
The HFA is committed to working with policymakers to achieve the recommendations set out in the HMI report in the interest of a health system that is transparent, affordable and efficient for all.
The recommendations will bring about more cohesive and efficient private and public healthcare sectors that will improve the quality of care experienced by patients.
Lerato Mosiah is the chief executive of the Health Funders Association.
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