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councilmedicalschemesBL Premium reports that up to 20-million South Africans from low-income households could afford basic private healthcare services if the medical schemes regulator stopped stalling on plans for cheap, pared- down benefit options, the annual Board of Healthcare Funders conference was told on Thursday.

The Council for Medical Schemes (CMS) is overseeing the development of a serially delayed framework for low-cost benefit options (LCBO), that will allow schemes to offer packages that are exempted from provisions in the Medical Schemes Act that require cover for a much broader basket of care, known as prescribed minimum benefits. It has been prevaricating over the LCBO framework since 2015, leaving millions of people from poor households paying out of pocket for private primary healthcare services, such as GP consultations and dentistry, because they cannot afford full medical scheme cover, said Insight Actuaries & Consultants joint-CEO Christoff Raath. While 15% of the population belongs to a medical scheme, the 2020 general household survey found 28.2% of the population turned first to a private healthcare provider when they needed care. “These are the families that can least afford R400 or R500 to go to a doctor. The question we have to ask is why is nothing being done about it?” Raath queried. The advisory committee established by the CMS in 2020 to finalise the LCBO framework had completed its technical work and there was no need for further consultation, he said. An estimated 10-million people from low-income households could be covered by low-cost benefit options, which had been priced at between R124 and R166 a month. If the Treasury scrapped medical scheme credits and used the money to provide a R100 monthly grant towards low-cost benefit cover, the figure could rise to 20-million people, or a third of the population. Speculation that the ANC had put pressure on the CMS to put the brakes on the LCBO framework because it might pose an impediment to National Health Insurance (NHI) would be a “moral tragedy” if true, Raath said.

  • Read the full original of the report in the above regard by Tamar Kahn at BusinessLive (subscriber access only)

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