South African Health Review 2022: health systems recovery after COVID-19

Abstract

There have been extensive changes to the law governing medical schemes in the last two years. Implementation of much of that law only began in January 2000. The legislative changes represent underlying changes in government policy in favour of increased regulatory control, not only of medical schemes but also contractors to medical schemes such as medical scheme administrators, managed care organisations and brokers. The chapter explores these legislative changes, issues surrounding their implementation and responses by the medical schemes industry to date. Initially the legislation, the Council for Medical Schemes and even the Minister of Health were all challenged by a number of powerful stakeholders within the industry on a few important issues, namely, the lines of demarcation between insurance business and the business of a medical scheme, re-insurance of medical schemes, and the promulgation of additional regulations relating to waiting periods. This chapter examines the changes in the functions of the Council for Medical Schemes in the light of the legislation's more consumer-oriented approach. The effect of the legislation on medical scheme contributions is discussed and some scheme membership figures are presented. It also offers a brief look at the implementation of the prescribed Minimum Benefits Package by schemes from a consumer's point of view.