Medical aid providers at odds with ‘abolish private medical aid’ utterances

By Samantha Orange


At a recent panel discussion of the National Health Insurance (NHI) white paper, SA Health Professions Council president Dr Kgosi Letlape said the current private medical scheme set-up is a crime against humanity and should be abolished.

Half of South Africa’s health professionals cater exclusively to only 17 per cent of the population who are members of a medical aid scheme, he continued. Furthermore, private healthcare in its current form can’t exist with government’s proposed NHI system, as the privileged few who have access to medical aid – including those in government – refuse to engage.

His utterances have been met with widespread disapproval from medical aid providers and the Hospital Association of South Africa (Hasa). Many in the industry have hit back, saying that he is targeting a single sector when the entire health sector is facing challenges. “Unfairly targeting one sector of the healthcare system, which provides cover to millions of South Africans who are able to receive necessary treatment, while ignoring challenges like the debilitating shortages of doctors and specialists‚ the lack of infrastructure and the falling numbers of public sector hospital beds‚ is not helpful‚” says Melanie da Costa, chair of Hasa.

For Genesis Medical Scheme, Letlape’s declarations, which are in direct contrast to the health minister’s stance, is a tough pill to swallow. Health Minister Aaron Motsoaledi has regularly reassured the public and the industry that the purpose of the NHI is not to destroy the private healthcare sector but to make it possible for more South Africans to access quality healthcare.

Six months ago, Motsoaledi said at a briefing held by the Board of Healthcare Funders (BHF), “There is no plan, secret or otherwise, to destroy private healthcare providers in the country. What we are saying is that private healthcare has a lot of resources which are not available to everyone. We are not saying it must be destroyed [but it should] make it possible for [them] to be utilised by all South Africans.”

There are issues that Letlape has made no mention of, such as the egregious amounts some doctors are charging under the guise of Prescribed Minimum Benefits (PMBs), explains Elmarie Jensen, marketing manager of Genesis Medical Scheme. “The issue then is one of considering whether the public can afford such charges if there was no insurance. There seems to be little difference to suggesting that everyone that owns a house cannot have insurance against fire. Without insurance, great financial hardship will be created,” she warns.

Grace Khoza, director of group marketing and corporate affairs at AfroCentric Group, says that a blanket approach of abolishing one component of healthcare may be simplistic and can ultimately not resolve challenges of healthcare in the country. The resource limitation is one of the key challenges that the NHI will face. Collaboration between all sectors will go a long way in dealing with this challenge. Khoza believes the NHI will succeed, especially when critical skills and expertise that are present in both public and private healthcare are retained.

She points out that as a way of supporting government, a number of private healthcare stakeholders have collaborated to form Public Health Enhancement Fund (PHEF). The fund contributes over R50 million per annum towards government’s efforts of creating capacity and infrastructure in the public health sector.

“Medical aid is to assist people in defraying medical expenses in times of need. The Medical Schemes Act (MSA) even defines the business of a medical scheme as the business of undertaking liability “to grant assistance in defraying expenditure incurred in connection with the rendering of any relevant health service….” No mention is made of “pay it in full”, but to “defray”, which means to settle in whole or in part. Without medical aid, the public will be driven to the state that clearly cannot handle the volume. Private hospitals will be closed and there will be a shortage of hospital beds to treat the ill,” says Jensen from Genesis.

In contrast to Letlape’s view, the minds of many public-private partnerships are the most practical and most effective solution to making the NHI a reality.