It is all systems go for the Council for Medical Schemes (CMS) following the Minister of Health, Dr Aaron Motsoaledi’s endorsement of the regulator’s new plan for operation in the National Health Insurance (NHI) environment. Addressing the CMS staff, Minister Motsoaledi applauded the regulator for the proactive initiative in aligning its vision for functioning within the NHI environment.
The meeting which was attended by members of the CMS board, unveiled the regulator’s five-year plan to support South Africa’s vision to provide Universal health coverage (UHC) for everyone.
“There is nothing to be feared about the NHI which has produced good results elsewhere in the world. I am happy that the CMS’ new vision is in line with the National Development Plan (NDP) which has been adopted in Parliament”, Minister Motsoaledi said.
“One of the two targets set out in Chapter 10 of the NDP under the UHC topic, is that everyone must have equal access to healthcare services by 2030; the other target is aimed at the establishment of a common fund for healthcare services for all, regardless of income. The NDP in this regard is referring to the NHI, and we are going ahead with it. In fact, we have now entered the second phase of the implementation of the NHI, which entails putting systems in place”, said the Minister.
The new Chairperson of the board of the CMS Dr Clarence Mini, highlighted some of the CMS’ key focus areas for the new five-year cycle, which include among others:
Strengthening the CMS’ Policy, Research and Monitoring capacity.
Provision of technical support for the NHI which will entail the review of the current prescribed minimum benefits (PMBs); the creation of a forum for current government schemes; and the consolidation of benefit options.
Implementation of the Health Market Inquiry (HMI) recommendations.
Building of capacity for the CMS to effectively deal with Fraud, Waste and Abuse (and go beyond advocacy).
Cost interventions for managed care.
Establishment of a coding authority.
Building capacity for regulation of Health technology interventions.
Coordination of medical funding regulators in the Southern African Development Community (SADC) region, which entails the harmonisation of scheme regulatory framework; establishment of ties with all role players in the SADC region and provision of sound policy advice to the SADC secretariat on scheme regulation.
As part of putting systems in place for the NHI, Minister Motsoaledi indicated that several legislations in the healthcare sector are going to change. He pointed out that the legislation governing the regulator, the Medical Schemes Act, is among the 12 pieces of legislation, including the National Health Act, that have been identified for review by the Law Reform Commission as part of creating an enabling environment for the roll out of the NHI. “On 28th March, I signed a memo to Cabinet to review the Medical Schemes Act. There is a need to extend the functions of the CMS, including among others, a review of the manner in which the regulator deals with beneficiaries, benefit options, the provision of health plans by other entities currently not regulated by the CMS, as well as brokers”, Minister Motsoaledi said.
The Minister promised to appoint a permanent Chief Executive & Registrar for the CMS very soon, in order to avoid instability in the organization. He also made a commitment to visit the regulator frequently. He pointed out the fact that a lot of skills are needed for the roll out of the NHI, saying that the CMS stands to play an important role in this regard.
UHC is about social solidarity and cross-subsidisation between the rich and the poor, the young and the old, and the healthy and the sick. It addresses larger socio-economic goals such as poor economic growth, poverty and inequality. This is necessary in South Africa particularly due to the fact that the country is among those with the highest income inequality, demonstrated by the Gini-coefficient.
Minister Motsoaledi highlighted the fact that the majority of people who need healthcare support are currently without health cover. These he said, are the poor who are mostly affected by the social determinants when it comes to health issues.
“It cannot be business as usual. The world is moving very fast towards the UHC, sadly, Africa is moving very slow. It is time for South Africa to take the lead on the provision of UHC”, the Minister said. “South Africa is moving away from a curative healthcare system to primary healthcare. We must deal with the misconception that primary healthcare is for the poor. The quadruple burden of disease must be reduced, and primary health care is the best vehicle to achieve this”, he added.
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