Picture: THINKSTOCK
Picture: THINKSTOCK

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THE Council for Medical Schemes (CMS) has withdrawn its guidelines for low-income medical schemes in response to criticism from key stakeholders such as the South African Medical Association, dealing a blow to medical schemes that planned to launch such products early next year.

The CMS said on Thursday it planned to publish revised guidelines as soon as possible, but did not specify a deadline.

Last month the council approved an exemption framework to the Medical Schemes Act that created the legal space for cheap but pared-down medical scheme products, dubbed low-cost benefit options.

It also published guidelines spelling out the minimum mandatory benefits that these options should provide. These were roundly criticised by the South African Medical Association (Sama), which is SA’s biggest doctor organisation.

Low-cost benefit options are intended to expand the medical scheme market, which is currently out of reach of millions of lower-paid people in formal employment, and represent one of the most significant policy developments since the Medical Schemes Act came into force more than 10 years ago.

The CMS estimates this untapped market could be as high as 15-million beneficiaries. The CMS initially anticipated that medical schemes could begin offering low-cost benefit options as early as January, from as little as R180 a month. They are cheap because they do not have to include cover for prescribed minimum benefits, which is a requirement of the Medical Schemes Act. Nor will they provide care in private hospitals.

"The CMS had to revisit the benefit package due to some constituencies’ request to the minister (of health) and the CMS to revise the package. These constituencies requested revision of treatment of some common medical disorders to be included in the minimum package," said CMS head of stakeholder relations Elsabe Conradé.

Sama said last week the benefit package was inconsistent with current clinical practices and national policies.

It said the package design promoted "cream skimming" because it did not include cover for HIV/AIDS or heart disease and thus discriminated against people with these conditions.

"South Africans are more likely to die from these conditions than some of the conditions included in the package," it said.

"Misalignment with national policies promotes fragmented and inequitable access to healthcare. Cream-skimming and geographical exclusion discriminates against the sick and rural communities.... In the absence of equity, efficiency, health and financial protection, there is thus no real value added to prospective beneficiaries," it said.