The role of the Council for Medical Schemes (CMS) in the
proposed National Health Insurance system was not known, acting CEO
Patrick Matshidze said.
Releasing the annual CMS report in Pretoria, Matshidze said the
council was yet to receive the actual proposal from the department
of health outlining details of its involvement.
"Currently we are aware that there is a proposal for a major
overhaul of the entire health care system. The two systems [public
and private] have to merge into one.
"It would be premature to make any kind of announcement ... as
to what role the council will play."
Membership still on increase
Matshidze said the council would, however, should government require it, be able to provide technical expertise. "Job losses, it is something that we are mindful of," he said, adding that the council would not elaborate as it may adversely affect employees.
A white paper on the NHI is expected to be presented to
parliament early next year.
The NHI will see the merging of private and public health care facilities and has caused much anxiety for the future of the private sector, including medical aid.
Commenting on the report, Matshidze said that while there were fewer medical aids operating in the market, membership had remained on the increase. This however improved risk.
He said the effects of the government employment medical scheme, which was incorporating many open medical scheme members, would still need to be determined.
Claims, contributions have stabilised
The report showed that amalgamations and liquidations were more pronounced in restricted schemes were operated by employers.
The rate of contributions and claims also appeared to have stabilised even though the rate of increase in claims was higher than that of contributions.
Matshidze said some schemes were subsidising contributions from reserves to minimise the impact of contribution increases on members.
He said while membership had increased there had been a greater decline in utilisation. He added that the decline would need further investigation to determine the cause.
Of particular concern was the presence of unscrupulous medical aid brokers who were rendering "non-value" services, Matshidze said. – (Sapa, September 2009)
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