The Health Funders Association (HFA), representing over half of South Africans insured by medical schemes, has emphasised the urgent need for healthcare regulatory reforms.
These reforms are seen as pivotal in transitioning to the National Health Insurance (NHI) and ensuring the sustainability of health funding.
Phumelele Makatini, CEO of the HFA, highlighted that since 1995 there have been visions of transforming medical schemes into a social solidarity framework.
This would make it mandatory for individuals above a certain income bracket, complementing the public healthcare system. However, this vision remains unrealised.
Makatini said that experts believe mandatory cover and other reforms could reduce the costs of minimum benefit packages by 17% to 23%.
This could make quality private healthcare more accessible to a larger number of South Africans using existing resources.
In recent years, the viability of the current model has come under scrutiny.
Several medical schemes have either merged or liquidated.
Makatini emphasised the importance of medical schemes, as not-for-profit entities, to ensure members' contributions sufficiently cover all claims and maintain adequate reserves.
She pointed out that due to South Africa's incomplete regulatory framework, many find medical scheme coverage unaffordable.
"For the nation, it's imperative to progress towards the principles of social solidarity. This would enable individuals to access private healthcare without jeopardising their family's financial stability," Makatini added.
The CEO further noted that some provisions, such as community rating, open enrolment, and a comprehensive Prescribed Minimum Benefits (PMB) basket, have been introduced.
These align with Universal Health Coverage goals, ensuring risk cross-subsidisation and protecting members against significant financial loss.
However, the affordability of medical scheme coverage is currently threatened by high annual contribution inflation. This is primarily due to increased healthcare utilisation rates among members, driven by anti-selection, which adversely impacts all members and the industry.
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