eHealth News, South Africa

Medical Benefits Registry Causes a Stir

The NDoH's plan to develop a Medical Benefits Registry from private patient information has been called unlawful by the ANC’s main opposition, the DA.

Medical Benefits Registry - EHN

The National Department of Health’s (NDoH) plan to develop a Medical Benefits Registry from private patient information – including names and addresses – requested from the Council for Medical Schemes (CMS) has been called unlawful by the ANC’s main opposition, the Democratic Alliance (DA).

According to the NDoH, the proposed Medical Benefits Registry is intended to ensure that the public sector is able to identify medical scheme members so that their scheme can be billed for services rendered in the public sector.

A number of medical schemes have contracts with the public sector for their members to access services, however some members fail to identify themselves and provide accurate information regarding their scheme so that their scheme can be billed. As a result the patients are accessing services in the public sector for free, whereas they are being billed for these services in the private sector.

DA’s Spokesman on Health, Dr Wilmot James‚ has come out against the Medical Benefits Registry saying that the request of such information is a breach of the Constitutional right to privacy and the government had no right to each member’s personal information.

“The state has no right to our personal information and the CMS has no business in providing it. It cannot be that national government asks a national institution to break our own laws,” said James.

The NDoH has responded by saying that they had planned to develop a benefits registry for three years and it has been included in the annual performance plan of the department since 2014/15.

“Our annual performance plans have been approved by Parliament for the past three years. Developing the national registry has been part of the approved plans and no Member of Parliament ever raised a query,” said the NDoH.

The NDoH has also said that the Medical Benefits Registry will contribute to the National Patient Registry, a list of all patients in the country, which will be held on a central database as part of National Health Insurance (NHI). Such patient information will assist in planning and developing policy for the delivery of healthcare services.

“The objective here is to obtain summary information, not individual personal or private information. Personal medical information of individual members will not be made available,” said the NDoH.

“This information is critical for planning so that we appreciate which options members are choosing, what is the disease burden in the option, age profile and geographic distribution. It is not solely for research purposes as the DA claims,” continued the NDoH.

The NDoH added that they will respect the confidentiality of the patient data and they think they aren’t acting unconstitutionally in putting up a planning tool.

According to Section 42 of the Medical Scheme Act, the Registrar may require additional particulars. Section 42 (3) states that the Registrar may require such information as to enable the council to make recommendations to the Minister on the matter referred to in section 7 (c).

Section 7 (c) of the act states that the functions of the council include making recommendations to the Minister on the criteria of the measurement of quality and outcomes of the relevant health services provided for by medical schemes and other such services as the council may from time to time determine.

Section 7 (h) states that the council can perform any other functions conferred on the council by the Minister.

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