Healthcare Exco ReportMay 2013
CMS Broker Policy Document• Document applies to any person who provides services in terms of the Act and
Regulations
• Accreditation• Renewal Of Accreditation• Appointment of Brokers• Broker Agreements• Remuneration of Brokers• Re-signing of mandates and transfer of business• Complaints and Sanctions against Brokers
Demarcation• Government Gazette No. 9706, 2 March 2012, Draft Regulations
• Purpose:• Find a balance between medical schemes and health insurance products• Address the risk of young and health opting out of medical scheme membership in
favour of health insurance products
• Outcome of a joint process between National Treasury, Department of Health, FSB and CMS
Rationale, Why Gap Cover Insurance Products must be included in Regulations:
• Negative impact on members if withdrawn
• Short falls in medical scheme design
• Member affordability
• Financial Risk Protection (NHI Green Paper)
• GAP Products supplement rather than compete with medical scheme products
Concluding Remarks on Demarcation
• Consultation with Treasury
• Legal Action
• Imminent Revised Draft Regulations
National Health Insurance (NHI)
• Green Paper
• NHI ‘The First 18 Months’• White Paper (expected in 2013)• Public Hospital Infrastructure and Equipment• Human Resources• Information management and systems support• Public Health Facility Audit, Quality Improvement and Certification• Establishment of an NHI Trust• Population Registration
DRAFT TERMS OF REFERENCE FOR MARKET INQUIRYPRIVATE HEALTHCARE SYSTEM
• Purpose and Objectives
• PURPOSE• Conduct an analysis into selected segments of the private healthcare market
examining contractual relationships and how these dynamics impact on total private expenditure
• Assessment of the impact of Communial Interactions• Nature of price determination• Establish a factual basis for recommendations
• OBJECTIVES
• Evaluate Price Determination
• Evaluate Factors that have led to increases
• Make recommendations on policy, Regulatory Mechanisms, Price-setting Mechanisms
• Medical Schemes, Administrators, Brokers and Managed Care
• Relationships between Medical Schemes, Brokers and Administrators (understanding the nature of incentives in their relationships and impact on costs IE Administration)
Concluding Remarks
Discussion
Thank You
