Medical aid for all is planned in new medical schemes bill

Portfolio Committee on Health

Government’s intention that medical aid cover should be introduced by the private sector to lower income groups so that a much broader range of groups can benefit from this cover has now been mostly realised with the setting up of a state risk equalisation fund.

Nkosasana Zuma, when minister of health in the late nineties, gave notice of her intention to introduce such polices and, for the most part, the tabling of the Medical Schemes Amendment Bill before Parliament this week will see the road to this ideal being achieved.

The bill now tabled introduces a risk equalisation fund (REF) and establishes a regime by which all schemes will participate through a system of financial transfers from each into a common pool subject to pre-calculated risk factors.

Such will include transfers out of the pool according to set procedures with the purpose of embracing a wider target audience and a more all-embracing income group spread of health scheme beneficiaries in terms of government health policies set some years ago.

The bill sets procedures for transfer of funds to the REF, governance criteria, the establishment of principles for boards, trustees of such a fund and amending the powers of the minister to make regulations regarding the fund.

Although there have been subsequent discussions, meetings and discourse between medical aid providers and the department of health on the subject since the date of an original paper by the Board of Healthcare Funders of Southern Africa voicing objections to certain portions of the original 2006 draft, how this latest version of the Bill affects health providers will no doubt emerge during parliamentary hearings, not yet announced.

The wording of the bill makes it clear that in entirety the equalisation fund will be administered in accordance with the principal Act subject to the Public Finance Management Act, monies from the fund vesting in the Council for Medical Schemes. Consequently the minister of health has tabled the bill as a straightforward section 75 bill.

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