The medical schemes regulator says it is investigating the conduct of the actuary who publicly accused it last week of stalling the development of cheap, pared-down options aimed at low-income households.
The Council for Medical Schemes has since 2015 been overseeing the development of a low-cost benefit option (LCBO) framework that will allow schemes to offer cheap primary healthcare cover, exempting them from provisions in the Medical Schemes Act that require cover for a much broader range of services, known as prescribed minimum benefits.
Last week, Insight Actuaries & Consultant joint CEO Christoff Raath told the Board of Healthcare Funders annual conference that the lack of regulatory reform meant millions of people from low-income households are paying out of pocket for private healthcare services such as GP consultations and dentistry, because they cannot obtain affordable cover. “These are the families that can least afford R400 or R500 to go to a doctor. The question we have to ask is why is nothing being done about it,” he asked in a presentation to delegates on Thursday. Raath is a member of the CMS’s advisory committee on LCBO’s, which was established two years ago.
He said the technical work had been completed and questioned why the process was taking so long to finalise.
CMS registrar Sipho Kabane said Raath’s conduct undermined the work of the LCBO advisory committee, which was continuing in earnest and was “by no means complete”.
“The CMS has taken a dim view of this conduct and is currently examining this against the approved code of conduct and will be taking the appropriate action to preserve the integrity of the advisory committee and its work,” he said in a statement issued on Friday evening.
Kabane said once the LCBO advisory committee had completed its work, it would be sent to the CMS council and the health department for approval.
“CMS’s consultation of all stakeholders should neither be vilified nor undermined as [it is part of a quest] to ensure that the final outputs enhance the quality of care for members and that no stakeholder is left behind. Over the duration of the project, the CMS has received inputs from consumer groups, doctors, unions and brokers, amongst others. It would be amiss of the CMS to scupper those who contribute meaningfully to the process just to appease the loudest voice in the room,” he said.
The next meeting of the LCBO advisory committee was scheduled for June, he said.
Kabane said Raath’s assertion that up to 20-million people could be covered by LCBO options was overstated, as the advisory committee’s market and affordability workstream estimated the figure at between 2.3-million and 4-million people. Raath told the BHF conference that an estimated 9-million people were currently paying out of pocket for private healthcare services, and that up to 20-million people could afford an LCBO package of R250/month if medical scheme tax credits were converted into a R100/month government subsidy. A R100 government subsidy would cost about R24bn to for 20-million individuals, compared with the R29.3bn currently given as rebates in the current tax credit scheme, he said. About 9-million lives were covered by medical schemes.
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