Our overarching objective is to advocate for a vibrant and sustainable private health sector within a well functioning and equitable health system.
Medical schemes and administrators continue to navigate an increasingly challenging environment. The population of medical scheme members has declined in real terms, driven by factors such as rising unemployment, emigration, and economic pressures. Prescribed Minimum Benefits (PMBs) are consuming an ever-larger portion of member contributions, straining the financial resources of schemes. Additionally, the industry is grappling with growing anti-selection and a significant rise in members with chronic diseases and mental health conditions. Regulatory uncertainty and an incomplete regulatory framework create additional pressures, making it difficult for schemes to plan and operate effectively.
These factors collectively underscore the need for robust advocacy, strategic interventions and a clear and unified voice to ensure the sustainability and resilience of the sector.
Strategic engagements with key policymakers are a primary focus. To this end, HFA has nurtured a constructive relationship with the Registrar of Medical Schemes and signed an MOU with the Council for Medical Schemes, further strengthening this relationship.
Our current key focus areas include:
NHI
HFA continues to pursue a dual strategy of constructive engagement as well as a robust legal response to the NHI Act.
During 2022, HFA submitted a complaint to the Competition Commission against Pathcare, Ampath, and Lancet, over their pricing of COVID-19 PCR tests during the pandemic in 2020 and 2021.
Categorization of Assets, Regulation 30 (4) (iii) and (iv)
HFA is committed to advocating for a review of Regulation 30 (4) (iii) and (iv), which we believe could positively impact schemes’ investment income, creating a pathway to potentially reducing member contribution levels.
HFA and several member schemes are appealing the Registrar of Medical Schemes' decision to declare certain practices regarding Designated Service Providers (DSPs) and co-payments as "undesirable."
RAF’s Directive on Payment of medical scheme member claims
HFA, and several of its member schemes supported the application by Discovery Health to compel the enforcement of the judgement compelling the RAF to pay claims while its appeal was being considered.
In August 2022, Transport Minister Fikile Mbalula and the Road Accident Fund promulgated new, reduced medical tariffs for medical professionals in the private sector.
Several strategic initiatives to foster innovation, improve efficiencies, and enhance the healthcare journey for medical scheme members are on HFA’s radar. In addition to the above key focus areas, HFA is actively pursuing the following:
HMI Recommendations and Value-Based Care (VBC):
Tariff Standardisation: HFA will actively participate in the industry-wide effort to standardise coding for more streamlined billing and service tracking.
High-Cost Therapies:
Health Technology Assessment (HTA):
Establishment of a Working Group to provide day-to-day support for schemes, particularly smaller and restricted schemes.
Please email us should you require further information on our key focus areas, This email address is being protected from spambots. You need JavaScript enabled to view it..
