New Medical Aid Rules Cause Jitters

There is an air of panic in the South African public after the Department of Health published new regulations regarding PMBs or Prescribed Minimum Benefits.

This is a list of 270 conditions, including 26 chronic diseases, that medical schemes are obligated to pay for on their members’ behalf in full by the Medical Schemes Act.

People fear that the new regulations will require patients to foot their own costs for some types of treatment.

Government and New Medical Aid Rules

Dr. Anban Pillay, the director-general of the Health Department, has moved to allay these fears. He says the reasoning behind the new rules is that if schemes are able to identify more cost-efficient healthcare providers, they will be able to device a benefit structure that does not require their clients to make co-payments whenever they seek treatment. This will make life easier for both the medical aid schemes and patients, leading to a win-win situation.

NGOs and New Medical Aid Rules

New Medical Aid RulesHowever, not everyone is convinced by this argument, especially not the Section 27 movement, an NGO that seeks to protect the rights of patients. A lawyer with the body, Umunyana Rugege, decried what he saw as a retrogressive measure. He wondered why the government felt a need to adjust a policy that already offered South Africans assurance of access to healthcare. He felt that the new stipulations would take away whatever access to treatment that existing legislation guarantees.

Medical Schemes and New Medical Aid Rules

Medical schemes on their part are only concerned with the sustainability of the new rules. Genesis, a registered medical aid scheme, actually took the government to court, claiming that medical schemes could not afford to cover PMBs. Many other administrators of registered schemes have expressed the same concern.