Medical schemes regulator hopes to finalise low-cost medical aid laws in 2023

[rvZA]

The Council for Medical Schemes (CMS) says it is closer to finalising low-cost benefit option (LBCO) regulations - the absence of which have prevented medical schemes from offering cheap medical aid options since 2016.

The CMS has been reviewing the LBCO guidelines since 2015, and according to the medical schemes representative body, the Board of Health Funders, the regulator has refused to grant its exemptions to continue selling these products since 2016.

In December 2019, the CMS announced plans to disallow LCBO altogether by the end of March 2021. But the industry pushed back, and the CMS extended the shelf life of these products up to 31 March 2024.

During the presentation of the medical schemes industry report on Thursday, CMS executive manager for research policy and monitoring, Michael Willie, said the regulator expected to finalise all public engagements on the matter this December and make its final submissions to the health minister in the first quarter of 2023.

Medical schemes regulator hopes to finalise low-cost medical aid laws in 2023 | Business

The Council for Medical Schemes says it is closer to finalising the low-cost benefit option regulations, the absence of which has prevented medical schemes from offering cheap medical aid options since 2016.

www.news24.com

 

[rvZA]

Meanwhile, while the demand for these cheaper options has been growing, the number of people covered by medical schemes in SA has remained stagnant for the past decade. The percentage of people covered by medical schemes has decreased from 16% in 2000 to 14.86% in 2021.

Heard from a medical aid that that number is below 10% this year. Time these aids get shut down. They are crazy expensive and are protected by a corrupt government and illegitimate laws.

 

[G'Wobblez]

Heard from a medical aid that that number is below 10% this year. Time these aids get shut down. They are crazy expensive and are protected by a corrupt government and illegitimate laws.

I think Doctors should be made to stick to prescribed rates.
Whats this BS with being a 300% practice?
My medical aid covers 100%. So the doctors just say : oh well we charge 200% on top of that.
That is absolute bs.
My mother had to have skin cancer removed
Their medical aid covered is 100% of all the procedures. But she still had to pay 200% extra.

This is Bs. We have a medical aid to ensure we are covered. But doctors screw you over

 

[PaulMurkin]

Good luck with that...

 

[ToxicBunny]

I think Doctors should be made to stick to prescribed rates.
Whats this BS with being a 300% practice?
My medical aid covers 100%. So the doctors just say : oh well we charge 200% on top of that.
That is absolute bs.
My mother had to have skin cancer removed
Their medical aid covered is 100% of all the procedures. But she still had to pay 200% extra.

This is Bs. We have a medical aid to ensure we are covered. But doctors screw you over

You can thank the government for that little gem as well since they stopped publishing the medical fees thing many years ago.

 

[Grant]

I think Doctors should be made to stick to prescribed rates.
Whats this BS with being a 300% practice?
My medical aid covers 100%. So the doctors just say : oh well we charge 200% on top of that.
That is absolute bs.
My mother had to have skin cancer removed
Their medical aid covered is 100% of all the procedures. But she still had to pay 200% extra.

This is Bs. We have a medical aid to ensure we are covered. But doctors screw you over

It's the medical schemes equally to blame - or the scheme itself.
My mother was in & out of hospital over the course of 3 yrs - multiple surgical procedures etc.
Total cost was R5.4m.
Total co-payments were under R5000.

But I also looked at some invoices.
Vascular surgeon was most expensive - theatre time @R1600 per minute.
However, the man studied for 12 years.
Despite living a long way out of town (constantia) he was doing rounds in the hospital by 7.30am - which means he left home around 7am - in turn, he is probably getting out of bed around 6am each day.
I would regularly see him doing rounds again between 7pm & 8pm - this would mean he is getting back home around 8.30pm.

So 12yrs of very difficult study leading to a 12hr working day in a stressful environment.
I tend to feel he earned the right to charge surgery at that rate

 

[G'Wobblez]

It's the medical schemes equally to blame - or the scheme itself.
My mother was in & out of hospital over the course of 3 yrs - multiple surgical procedures etc.
Total cost was R5.4m.
Total co-payments were under R5000.

But I also looked at some invoices.
Vascular surgeon was most expensive - theatre time @R1600 per minute.
However, the man studied for 12 years.
Despite living a long way out of town (constantia) he was doing rounds in the hospital by 7.30am - which means he left home around 7am - in turn, he is probably getting out of bed around 6am each day.
I would regularly see him doing rounds again between 7pm & 8pm - this would mean he is getting back home around 8.30pm.

So 12yrs of very difficult study leading to a 12hr working day in a stressful environment.
I tend to feel he earned the right to charge surgery at that rate

I agree, that should be the 100% we pay for.

 

[Mike Hoxbig]

I think Doctors should be made to stick to prescribed rates.
Whats this BS with being a 300% practice?
My medical aid covers 100%. So the doctors just say : oh well we charge 200% on top of that.
That is absolute bs.
My mother had to have skin cancer removed
Their medical aid covered is 100% of all the procedures. But she still had to pay 200% extra.

This is Bs. We have a medical aid to ensure we are covered. But doctors screw you over

Thing is, this is the free market that everyone wants. We can't have it both ways.

A good doctor with a good track record can name their price and they know it. Regulating doctors in order to regulate medical aids will just chase much needed skill overseas. We'll be left with cheap doctors to match our cheap rates. Which is a worse problem to have...

 

[vigras rojara]

I think Doctors should be made to stick to prescribed rates.
Whats this BS with being a 300% practice?
My medical aid covers 100%. So the doctors just say : oh well we charge 200% on top of that.
That is absolute bs.
My mother had to have skin cancer removed
Their medical aid covered is 100% of all the procedures. But she still had to pay 200% extra.

This is Bs. We have a medical aid to ensure we are covered. But doctors screw you over

What right does some third party company have to dictate to a profession what rate they are allowed to charge? On what authority do they "prescribe" rates?

 

[RiaX]

The medical aid 100% is a BS figure that they dreamed up and is totally out dated

Want to know why a MRI scan costs how much it costs ?

Well the machine is 10 to 15 million rand. The room requires specialized work to seal it , the electrical costs are ENORMOUS and it's coolant is 300k per month. Medical practices are a business they need to turn a profit. They are highly skilled so they deserve to be well paid for such services. It makes me sad people will pay ludicrous amounts of money for luxuries but not for their health.

I know for a fact that the medical aid rate of 100% for a MRI was below cost at one point.

Yes doctors are expensive and certain fields can be cheaper but not that cheap. Instead of blaming the practioner perhaps we should ask why the insurer (which is what medical aid is) is only paying one third of the claim.

We being conned they say 100% rate but in reality it's 33%

FYI they regulated pharmacy around 08/09 and they collapsed the industry for many people. Medicine cannot fall as well then our health system will collapse.

 

[RedViking]

Basic hospital plan on Discovery is now almost R4000 for a couple. Insane.

 

[ForceFate]

It's the medical schemes equally to blame - or the scheme itself.
My mother was in & out of hospital over the course of 3 yrs - multiple surgical procedures etc.
Total cost was R5.4m.
Total co-payments were under R5000.

But I also looked at some invoices.
Vascular surgeon was most expensive - theatre time @R1600 per minute.
However, the man studied for 12 years.
Despite living a long way out of town (constantia) he was doing rounds in the hospital by 7.30am - which means he left home around 7am - in turn, he is probably getting out of bed around 6am each day.
I would regularly see him doing rounds again between 7pm & 8pm - this would mean he is getting back home around 8.30pm.

So 12yrs of very difficult study leading to a 12hr working day in a stressful environment.
I tend to feel he earned the right to charge surgery at that rate

Our previous CEO lived 120km away but was at the office just after 6am, and left well after 5 on most days.

 

[rvZA]

Thing is, this is the free market that everyone wants. We can't have it both ways.

A good doctor with a good track record can name their price and they know it. Regulating doctors in order to regulate medical aids will just chase much needed skill overseas. We'll be left with cheap doctors to match our cheap rates. Which is a worse problem to have...

The time has come for SA then where every citizen should learn medicine so you can tell the doctor what to prescribe. As for technical operations, plan ahead and plan a trip abroad, else pass away in some State hospital. Our options are getting limited already.

 

[Mike Hoxbig]

The time has come for SA then where every citizen should learn medicine so you can tell the doctor what to prescribe. As for technical operations, plan ahead and plan a trip abroad, else pass away in some State hospital. Our options are getting limited already.

You're off your meds again...

 

[konfab]

It's the medical schemes equally to blame - or the scheme itself.
My mother was in & out of hospital over the course of 3 yrs - multiple surgical procedures etc.
Total cost was R5.4m.
Total co-payments were under R5000.

But I also looked at some invoices.
Vascular surgeon was most expensive - theatre time @R1600 per minute.
However, the man studied for 12 years.
Despite living a long way out of town (constantia) he was doing rounds in the hospital by 7.30am - which means he left home around 7am - in turn, he is probably getting out of bed around 6am each day.
I would regularly see him doing rounds again between 7pm & 8pm - this would mean he is getting back home around 8.30pm.

So 12yrs of very difficult study leading to a 12hr working day in a stressful environment.
I tend to feel he earned the right to charge surgery at that rate

The real vampires are the anesthetists. You don't really get to pick them.

But the bigger issue as to why doctors cost so much is yet again because of government regulations:
1) government will never allow a private medical school to increase the amount of doctors.
2) the government has made it illegal for a hospital to employ doctors. Therefore instead of the hospital figuring out a comprehensive package as to how much a specific plan of treatment will cost and thus allow insurance to budget for it, we have the expensive situation now, where every single doctor in a hospital has their own receptionist, nurses, rooms and equipment. And they have to pay their own insurance.

Just getting rid of that and allowing comprehensive care at hospitals will very much reduce the cost of healthcare.

 

[Moto Guzzi]

Well a good start, my medical aid (Expensive waste) refused to pay for a new operation on current plan already expensive, so I moved up a plan at double the payments, guess what, after doing my sums, I realised I payed that year for the operation in full out of my pocket, they dont even pay out chronic medicine fully, I am a 100% profit to them. Before them, before 1992 the medical aid just work, was cheap and affordable, and an operation got done no questions asked, then came digital era, and the easiness of adding Rules & Plans on the fly, just F-Upped the whole complete scene for good.
So its time to look at this mal practices.

 

[Craig_]

You're off your meds again...

He is definitely never taking his crazy pills....

 

[RiaX]

The time has come for SA then where every citizen should learn medicine so you can tell the doctor what to prescribe. As for technical operations, plan ahead and plan a trip abroad, else pass away in some State hospital. Our options are getting limited already.

Lol you would still have to pay consult to get the doctor to prescribe.

Though you not entirely wrong it would be much cheaper to get radio therapy and chemo in India.

 

[surface]

Our previous CEO lived 120km away but was at the office just after 6am, and left well after 5 on most days.

It seems that most of the rich okes are likely to form part of my tribe so I am happy about their charges.

 

[rvZA]

Lol you would still have to pay consult to get the doctor to prescribe.

Though you not entirely wrong it would be much cheaper to get radio therapy and chemo in India.

It's okay.... by then our universities would have grinded through so many doctors, they will all be sticking pamphlets on robots advertising to help us with erections and increasing the length of our penises.