Advocating for the introduction of LCBOs, the BHF describes these as simplified medical aid packages designed to provide essential primary healthcare services. Picture: Henk Kruger/Independent Newspapers
The Board of Healthcare Funders (BHF) announced on Monday that their application to the North Gauteng High Court will argue for allowing medical schemes to offer Low Cost Benefit Options (LCBOs).
This case comes on the heels of a separate move by the Hospital Association of South Africa (HASA), which has decided to proceed with legal action against the National Health Insurance (NHI) Act, citing its current unsustainability.
The push for affordable healthcare is not new in South Africa. It recalls findings from the 2019 Healthcare Market Inquiry (HMI) report by the Competition Commission, which illuminated the rising costs within the private healthcare market.
The inquiry revealed that patients are often treated excessively, contributing to a phenomenon known as supply-induced demand, and identified regulatory decisions at national and provincial levels as significant root causes of these issues.
Advocating for the introduction of LCBOs, the BHF describes these as simplified medical aid packages designed to provide essential primary healthcare services.
“Despite the Council for Medical Schemes (CMS) passing a resolution back in 2015 to facilitate the offering of LCBOs, the implementation has remained stagnant for 10 years,” the organisation remarked.
They further allege that delays are primarily linked to the government’s impending rollout of the NHI.
BHF representatives emphasise the urgency of the situation, stating that millions of South Africans require accessible healthcare solutions immediately, rather than years down the line.
Their court papers argue that the implementation of LCBOs could unlock access to quality healthcare for at least 10 million people currently unable to afford comprehensive medical scheme coverage, leaving them reliant on costly out-of-pocket expenses.
Moreover, the BHF argues that LCBOs would also allow beneficiaries to claim medical tax credits, unlike existing exempted insurance products aimed at this specific market segment.
Importantly, LCBOs would be structured to ensure that higher contributions are not imposed based on the member’s age or health status, thus contributing to a fairer system.
They assert that such measures would alleviate pressure on the public healthcare system without incurring additional costs to the state, advancing the goal of achieving universal health coverage by 2030.
In contrast, HASA has raised concerns regarding the NHI Act, claiming that it is neither sustainable nor affordable in its current iteration. The association has urged for modifications to ensure that it serves all citizens equitably.
“We remain committed to engaging all stakeholders to develop a healthcare framework that benefits the entirety of South African society,” HASA stated, encouraging a cooperative rather than confrontational approach.
Despite initially deferring any legal challenge, HASA has now opted to move forward with a court case in light of the government’s lack of response to proposed adjustments and constructive criticisms surrounding the NHI.
This decision reflects a broader sentiment among healthcare providers, who are increasingly sceptical of the NHI’s potential to deliver on its promises to South Africans.
As these legal challenges unfold, the discourse surrounding healthcare access in South Africa reaches a critical juncture. The outcomes of these cases could not only reshape the regulatory landscape for medical schemes but could also define the future of healthcare provision in the nation, with millions of lives hanging in the balance.
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