The Times
5 August 2009
Adele Shevel   
NHI could shake up the entire healthcare chain

A delegation from Discovery Health met representatives from the Board of Healthcare Funders this week to discuss rejoining the organisation, which represents the private medical scheme industry.

Discovery has differing views from the BHF around policy issues, specifically on National Health Insurance.

Jonny Broomberg, deputy chief executive at Discovery, said the discussions were ongoing but the parties had agreed not to discuss the issue in the media.
The BHF represents private medical schemes, which collectively spend R64- million a year in South Africa.

Discovery, South Africa’s largest medical scheme administrator, resigned from the BHF in November last year along with Resolution Health.

The medical scheme industry is at an important juncture since it faces uncertainty with National Health Insurance, which has taken central stage on the government’s agenda, and could shake up the entire healthcare chain.

Last week, the BHF put forward the first proposal from private industry as to how to engage with the impending NHI.

Private medical schemes cover 7.5million people in South Africa, and Discovery is the largest with 2million members.

The broad objective of the NHI — as stated by the ANC — is to put into place the necessary funding and health service delivery mechanisms to provide healthcare coverage to all South Africans.

The model proposed by the BHF suggests that medical schemes and their administrators would collect contributions for NHI benefits from the NHI Agency — as opposed to from the members, as is currently proposed.

Medical schemes would offer the free benefits contained in the NHI package of benefits. Should a member want additional cover for a procedure not covered by the NHI package, members would have to pay.

Contributions for the NHI will be paid from payroll tax into an NHI fund. Medical schemes will collect contributions from the NHI fund, on behalf of the members of the scheme entitled to NHI benefits.