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News24 user Robert Beney seems to think so: he calls the BHF "a bunch of colluding lobbyists" in an open letter to News24, which elicited much comment from other users.

On its own website, however, the BHF describes itself in a somewhat more flattering fashion: "BHF is the representative organisation for 95% of medical schemes throughout South Africa, Namibia, Zimbabwe, Botswana as well as Lesotho. As the industry representative body, the organisation relies on the membership of all medical schemes to ensure that it is able to lobby government and other organisations effectively and to influence policy where necessary on behalf of the entire industry."

The basics
What is actually going on, and why should we take note?

There are four basic players in the world of medical schemes:

• The medical scheme members (represented by the regulating body, the Council for Medical Schemes – CMS)
• Medical schemes themselves (represented by the Board of Healthcare Funders - BHF)
• Private healthcare providers (represented by, among others, the South African Medical Association – SAMA – and the Hospital Association of South Africa - HASA)
• The government (represented by the health department)

In the last decade, the government has become increasingly concerned about the high prices of private medical care and medication in South Africa.

"Efforts to regulate the industry, make medical scheme membership more affordable and to enforce regulations regarding minimum prescribed benefits, reserves, and membership applications have led to a huge shake-up in the whole industry," says Johan van Tonder, an independent medical scheme researcher.

The right to publish
But back to the BHF application. Should we read something sinister in that?

"Not necessarily," says Janine Louw, principal medical officer for the Naspers Medical Fund. "THE BHF merely wants to clear its name and indicate that there was no wrongdoing on its part in the past."

The issue at stake, it seems, is the right to issue official medical scheme rates tables. The BHF used to publish a tariff system, but was taken to court in 2003 by Bestmed medical scheme for using its tariff and code-numbering system. That court found that the behaviour of the BHF, HASA and SAMA contravened the Competitions Act.

The result was that the government then issued what it called the National Health Reference Price List (NHRPL), providing a guideline for the fees at which providers of medical services should be reimbursed. These guidelines were in place for several years, and were published jointly by the CMS, but were not issued in 2007, causing a general flutter in the medical scheme industry. Most medical schemes simply used the old rates, and added a set percentage onto them. The rates were issued again in 2008.

The different role players are at loggerheads (in courts and outside of them) about who actually owns the right to publish these rates tables.

SAMA has always issued rates tables of its own, in many cases 300 – 400 percent above the tariffs recommended by the NHRPL. Until now, market forces have determined what doctors in private practice could charge for their services. Medical schemes are, however, not obliged to pay these charges in full. Hence the co-payments many medical scheme members have to make when they visit specialists in private practice.

Those in private practice say that the government and the CMS do not have adequate insight into the real costs of running private medical care – and the government is of the opinion that private medical care is often a rip-off for the consumer, and that it needs to be regulated more strictly.

The battle continues – for the individual survival of the medical funds, for the protection of the consumer, for the 40 million South Africans who do not have medical cover, and for the right to publish medical scheme tariff tables.

(Susan Erasmus, Health24, April 2008)
 

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	Medical schemes 4/5/2008 6:50:16 PM Medical schemes are run for the sole purpose of maximum profit, and pay dividends to shareholders. They should be not-for-profit organizations. They abuse members, while pretending to be on their side. Try getting a medical Aid to pay for complications after surgery and see what the response is. - The Wizzard   solutions is not exemption 4/6/2008 12:33:58 PM The solution to collective bargaining is not exempting BHF members from the provisions of the competions act. That's like saying the solution to sadam husseins dictatorship is allowing US force carte blanche in the middle east. you don't deal with a monster by creating another.. - aelric   Employers conspire with them 4/6/2008 1:35:37 PM What’s even worse is that most employers force you to be on certain medical aid schemes, so you can’t even change when they increase their rates or give you bad service. Wonder why they do this?? - avesh   Blame the government 4/6/2008 7:47:25 PM No one likes an insurer, but the REAL problem here is that the government runs the industry in a socialist way. Imagine if a careful driver had to pay the same car insurance as a reckless driver with a poor record of accidents. Yet this is exactly how the medical scheme industry is run: it is illegal to charge lower premiums to people who look after their health! This is what drives up the cost of medical insurance for everybody. - Paddy   Already being ripped off 4/7/2008 7:43:05 AM What do you mean "Will we be ripped off?" They have been ripping us off for many a moon. Organizations such as Discovery who provide shoddy medical aid but great returns for investors should be taken to task. Sure, they should be allowed to make a small profit or they wouldnt be viable, but not huge profits at the expense of people who really need their medical cover. - Simon   The Wizzard - get your facts straight 4/7/2008 8:21:42 AM Medical aids ARE NOT FOR PROFIT organisations BY LAW. Their holding companies make profits for their shareholders from their profit producing susidiaries, eg in the case of Discovery these would be Vitality, Discovery Crd, Discovery Life, etc and these subsidiaries are separate entities with their own co. registration numbers. Any excess of subscriptions over expenses that a medical aid has are added to the reserves of the medical aid for when they may be needed. - Margaret   Politics 4/7/2008 8:56:12 AM Gee wizz Margaret, maybe you should be a politician. I worked in the Medical Aid industry for 5 years and trust me their holding companies want to see big profits - Panduranga Kumar   Quite right Margaret 4/7/2008 8:58:53 AM There is a common misconception that the total contributions paid to a medical scheme contribute directly to the profits of the administering company. In fact the administering company takes a small percentage of the contributions to cover their expenses and to give them profits. The rest of the contributions go to pay claims, with any excess going into the reserves of the scheme. Healthy reserves would help to restrict future contribution increases, as well as help to ensure solvency. - Trev   Can still be a rip-off 4/7/2008 9:03:46 AM In case my previous comment is taken as suggesting that medical scheme administrators are totally innocent, I must add that they can still be ripping off the members. One needs to look at the amount they take from the schemes in administration fees. It is quite likely that these fees could be excessive. - Trev   Quality Care 4/7/2008 9:31:07 AM Medical Specialists are in training for no less than 14 years to be specialists in their field. In this 14 years they get paid a joke of a salary! Pay specialists what they deserve! "Pay peanuts get monkeys!" Be careful public: before you know it most of the medical doctors will also just leave SA to go to markets where they get paid what they're worth. You'll be stuck with shaky Tunisian and Cuban "doctors". Good luck with that operation or pneumonia in 2012! - John   Sponsorship 4/7/2008 10:05:57 AM Why do we see such a lot of sponsorship of sports teams by medical aids? Should they not rather concentrate on their processes and systems and payments of medical bills or use the money to prevent major premium increases? If you query the lack of payment of claims, the new system is blamed, but the same company sponsors soccer or rugby teams. (I am sure the payers are not all on the specific medical aid). Why should we (the members) sponsor sports without our consent? - Rene   Why shouldn't they make profits? 4/7/2008 11:31:46 AM Administrators have as much right to make profits as hospitals as some of the extremely wealthy surgeons I have come across. Let's cut the socialist drivel and let the industry run without dum govt intervention. That will bring competition to the market and drive down costs for the consumer that way - then we don't have to have this debate about BHF negotiating with the hospitals. More regulation will only make things worse. - Paddy   medical aid 4/7/2008 2:54:32 PM Discovery should stop calling themselves a medical aid as it does not really cover medical expenses - they have all the exlusions when it come to medical conditions so they should rather call themselves lifetstyle cover or something- One takes on a medical aid because they need covmer for all those medical procedures and treatment - discovery becomes concerned about movie, air tickets and magazines - this should be a "real added on benefit and not the focus as one get no benefit medically. - Teboho Sepanya   What's the alternative, Teboho? 4/7/2008 3:10:14 PM The reason Discovery has Vitality is that it has realised that if members try to keep healthier it means paying out less. Exactly the same as if people try to drive more carefully, they claim less from their motor insurance. Trouble is, thanks to the crazy overregulation of medical aids, it's illegal to reward healthier people with lower premiums, as you can do with motor insurance. So Discovery has to reward its healthier members with gimmicks like movie tickets, credit card discounts, etc. - Paddy   Medical Aid Benefits 4/7/2008 9:22:45 PM I can also give a thought about what people comment above, but that not what really bugs me about them. Why do medical aids makes more available to certain catagories that people seldom needs. Can't they just put it together in one package and you can use it for whatever medical treatment you need. My scheme has a lot of funds available for treatment I'll maybe never use and not for what I really need. Example - How many people at an age of 40 will need a heart transplant or bypass. - Johan Groenenberg   Medical Aid Benefits 4/7/2008 9:26:46 PM To continue with the previous. About no money available for normal doctor visits and medicines. And then they tell you which doctor you could visit, from which is only one available in our town. When he's not available, I have to drive 53km to see a doctor. - Johan Groenenberg   You got a problem - tough luck 4/11/2008 9:35:29 PM Have been a member of Nimas for over 30 years and they will not allow collection of chronic meds until 4 days before last lot run out Inconvenient, when it is friday and you do not need to shop again for another week.Try speaking to an agent and he was most unhelpful and lots more that l could write but wont!!!! - Gloria Wilson
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