The findings and recommendations highlighted in the provisional report issued by the Health Market Inquiry (HMI) underline the urgent need to change the way medical scheme options are designed says Jeremy Yatt, Principal Officer of Fedhealth Medical Scheme.
“Although there is very little room to manoeuvre due to legislative constraints, medical schemes should find ways to empower members by addressing their concerns around affordability, transparency and flexibility,” he says.
Over the last six months Fedhealth has carried out extensive research with its member base and the overriding message is that members want to be in control; they want flexibility and they want choice.
“Members want more of a say over what their cover should be; how their daily benefits are used and they don’t want to pay for benefits they are not using. Therein lies the opportunity. There is not one medical scheme in South Africa that offers that level of flexibility,” says Yatt.
Unfortunately, medical schemes have been doing the same thing for decades, with very little differentiation between schemes.
“While many claim to be personalised to an individual, the reality is that personalisation only stretches as far as placing that individual into a generic category and benefit group that more or less fits one facet of their lives. There is little transparency and members have limited control over how their money is allocated,” he says.
Medical Schemes have also been hamstrung with legislation for many years now making it difficult for schemes to be innovative. Unlike other forms of insurance medical schemes are prohibited from rewarding or penalising members for modifying their behaviour.
“Nevertheless, the HMI’s provisional report highlights the urgent need for change and it’s time for the medical schemes to step up to the plate. We believe it’s time for a new approach that is going to transform the industry. Watch this space,” concludes Yatt.