In response to a press statement released by the Registrar of Medical Schemes on the Council for Medical Schemes’ website yesterday, the Board of Healthcare Funders (BHF) wishes to reassure members of medical schemes that the submission of proposed amendments to medical scheme rules is a standard process which occurs annually.

Members of medical schemes mentioned in the article should also be reassured that in terms of the Medical Schemes Act a registered scheme plan will not automatically lapse. The current rules of the scheme and corresponding plans are binding on the scheme and therefore, where rules are turned down by the Registrar, it is the amendments which are being turned down and not the plan itself.

Consequently, the rules which were approved by the Registrar for 2006 continue to apply and if the proposed amendments to the option are not approved, it simply means that the option will carry on as it did in 2006. However, we are confident that the issues raised by the Registrar will be adequately resolved by the schemes referred to before the 1st January 2007.

Of the 90 options not approved by the Registrar the majority are not rejected outright, but require a revision by the schemes to assess the impact on members and on contributions.

For further information, please contact Heidi Kruger, Head of Corporate Communications at BHF on (011) 5370200

The Board of Healthcare Funders of Southern Africa is concerned that moves by SAMA to halt the publishing of the NHRPL for 2007 will thwart the medical schemes’ industry and government’s attempts to bring about greater affordability and access to private healthcare.

The National Health Reference Price List provides medical schemes with guidance in terms of reimbursements to healthcare providers and without this guide, fees charged by healthcare practitioners may spiral.
“Our concern is that more healthcare professionals would gravitate towards the Health Profession’s Council price list which is on average 300% higher than the NHRPL, with some doctors charging as much as 500% of the NHRPL”, said Dr Rajesh Patel, Head of Benefit and Risk at the Board of Healthcare Funders.

BHF’s preliminary analysis of claims data for the first half of 2006 indicates that specialist costs have risen by 20% in-hospital and 30% out of hospital, about 5 times higher than CPIX. This trend undermines attempts through the Health Charter and the Low Income Medical Schemes initiative to bring about affordable and accessible private health cover.

“The methodology used by the Health Professions Council of SA to arrive at their price list has also been brought into the spotlight by BHF as, in terms of legislation, these prices are meant to reflect the ‘norm’, said Dr Patel. “It is therefore difficult to understand how costs which are 300% higher than the NHRPL can be seen as a norm”, he said

BHF will be engaging with the Department of Health as well as the Council for Medical Schemes on the way forward and to ensure that stability is maintained in the medical schemes sector.