Lynne Carlisle: Business Day,

WIDESPREAD changes to SA's present range of prescribed medical benefits (PMBs), formally under review, have been proposed to the government by the medical schemes sector to make private healthcare affordable to more South Africans and extend cover to members.

Heidi Kruger, head of corporate communications at the Board of Healthcare Funders (BHF), says the concept of a standard, basic set of health services provided by every medical scheme for the protection of its members is laudable.

However, she says the current set of PMBs set out in the Medical Schemes Act of 1998, which consist of 271 referred-based conditions and 25 chronic conditions, have had many unintended consequences, including:

Application for exemption from the provisions of the Competition Act - 14 March 2008

The Competition Commissioner’s ruling of 2004 which was aimed at promoting more competition in the private healthcare market and driving costs down has had the opposite effect. Instead, since the ruling, expenditure within this sector has soared.

The Board of Healthcare Funders (BHF) has on behalf of its members, 85% of medical schemes in South Africa, applied for exemption from provisions of the Competition Act No. 89 of 1998 that prohibits the medical scheme industry from working as a collective on matters such as setting tariffs and defining patient benefits.

The application seeks to deal with a host of unintended consequences arising from a ruling by the Competition Commission in 2004 that banned collective bargaining in the sector. This has brought about concerns on the continuity and the productivity of the medical scheme industry as a whole.

The key areas which the Board seeks to promote through the application exemption are: