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NEHAWU welcomes draft health insurance regulation

NEHAWU welcomes draft health insurance regulation
07-05-14 / Staff Writer

NEHAWU welcomes draft health insurance regulation

"It is our understanding that the mandate of the National Treasury primarily pertains to the fiscal policy (tax and spending policies) and to some extent monetary policy (working with the South African Reserve Bank). National Treasury must build its capacity to monitor spending by departments to ensure that there is no wasteful and fruitless expenditures, rather than creating social security systems where its narrow technicist approach has revealed its limitations."

The union said it recognizes that these recently published regulations are designed to tighten the conditions, under which insurance companies can sell health insurance products. However, it further explained that these health insurance products are peddled by the private sector, because of the continued commercialisation of health care and the absence of a comprehensive social security system, of which the National Health Insurance is a critical pillar, and on which National Treasury continues to prevaricate.

"These new draft regulations do provide additional protection against health-related risks and, in addition, they aim to complement medical schemes, without undermining the social solidarity that schemes provide by pooling contributions and covering claims."

"Health insurers will not be able to sell new combined policies. The current combined policies combine hospital cash plans or plans that cover hospitalisation after accidents with access to a network of general practitioners with limited benefits, and have been deemed to undermine the pooling capacity of medical aid schemes. The regulations also allow for the continued sale of medical gap cover policies, which cover the difference between what a health practitioner charges and what the medical scheme pays. However, the gap cover policies will now be subject to annual benefit limits," the union stated.

HEHAWU also pointed out that that premiums of the health insurance packages referred to in the draft regulations are often tantalizingly low and invariably attract younger people. "The companies that sell this insurance further attract low earners with promises that cash will be paid on admission to hospital. This is in itself an incentive for greedy private doctors to have patients admitted when procedures could be done locally. And, of course the private hospitals are laughing all the way to the bank"; it said.

But these health insurance products also come without the benefits, it said, which regulated medical aids provide. One of the most important aspects of these draft regulations is the unlimited cover for the prescribed minimum benefits (PMBs) which covers all medical emergencies and life-threatening conditions, as well as a number of chronic conditions. This cover is possible because medical aids pool funds so that younger healthier people subsidise the costs of the sick and the elderly. The solidarity pool is severely compromised when younger people are attracted away from medical aids by insurance companies.

The union conceded that these draft regulations will be an advantage for those people who are able to afford to buy private medical cover, it wanted to also remind South Africans that only 16% of the population is able to make use of private cover. It said the remaining 84% cannot afford any of this cover and if forced to use the private sector, they must pay from their own pockets.

"NEHAWU will never be persuaded that this short-term tinkering with health financing by National Treasury is a real long term solution to the provision of universal health care to the people of South Africa. We remain committed to the introduction of a National Health Insurance which will provide health care free at the point of service to all South Africans irrespective of one's ability to pay. We further remain committed to funds from the state being pooled with contributions from the employed public and private employers into a publicly administered National Health Insurance Fund."

"We caution that these regulations cannot have a lasting impact on the financing of health care, and therefore on the health status of the country," it concluded.

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