The current system that governs the funding of private healthcare is unsustainable and out of balance with the objective of providing universal healthcare. However, it is not all gloom. This is according to the Head of the Benefit and Risk Division of the Board of Healthcare Funders of Southern Africa (BHF), Dr Rajesh Patel, who was speaking in the run-up to the 19th Annual BHF Conference to be held in Sun City from 17 to 20 June 2018.

There are opportunities for the private healthcare industry to begin alignment with the principles of universal health coverage (UHC) by putting the health citizen first. Medical aid schemes need not rely on legislative reforms to effect positive changes to the provision of healthcare to the poor and sick. Structural reforms will ensure that the goals of UHC are achieved without crippling the existing healthcare system.

The private healthcare industry is characterised by fragmentation, which impedes effective and coordinated provision of service. As an industry it is important that we chart a way forward that will ensure that we strike a balance between achieving the goals of universal access to healthcare services and develop and sustain the healthcare sector.

We don’t have to wait until the full roll-out of National Health Insurance (NHI); the medical scheme industry can begin to effect change and find alignment to the policy reform.

Due to fragmentation in the system, the BHF proposes that schemes consolidate their benefit options and further simplify them for the medical scheme members to understand their cover. With escalating healthcare costs, medical aid contributions have become unaffordable for the medical aid member; as such there are a number of strategies that have been implemented to reduce the cost of healthcare.

The BHF urges that it would be prudent for schemes to sign performance-based contracts with healthcare professionals as opposed to the fee for service model. Furthermore, for all plans benefits should be accessed via a nominated medical practitioner.

The medical aid industry can begin to take bold steps to align with NHI and to drive the transformation of the sector. There are preventable ailments that require outpatient care rather than hospitalisation – patients can make substantial savings and membership of medical aid schemes can be more attractive from a pricing perspective.

The reality of the situation in South Africa and across the region is that we should also consider the cross-subsidisation of the elderly and the sick by the young and healthy. At the same time, we are ever conscious of the need to maintain the affordability of, and inclusive approach to, medical scheme membership.

It is encouraging that the healthcare sector is unanimous about the importance of attaining UHC, but we need to reach consensus on the finer details and start moving forward.

The 19th Annual Board of Healthcare Funders of Southern Africa Conference will focus on action steps that the industry can begin to implement, without having to wait for legislative reforms. These steps are in areas such as strategic purchasing, pooling, non-healthcare costs, benefit design and industry collaboration, among others.

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