FOR IMMEDIATE RELEASE
06 October 2015
Media statement on Low Cost Benefit Option (LCBO)
The South African Medical Association, (SAMA), believes very little value has been added to prospective beneficiaries by the new Low Cost Benefit Option Framework, (LCBO), recently approved by the Council For Medical Schemes and due for implementation in January next year.
BACKGROUND
The LCBO is intended for scheme members with an annual income of below SARS determined tax threshold in order to increase the number of medical aid beneficiaries. This is a population that will normally consult for cash, alternatively accessing public health facilities.
The advantage of risk pooling is that funds are pooled to provide adequate health cover. However for risk pooling of funds to work effectively, there should be open & compulsory enrolment for formally employed, community rating, risk equalisation and prescribed minimum benefits (PMB’s). The PMBs are intended for the financial and health protection of members, as well as allocative efficiency between the public and private sector.
Allocative efficiency refers to how scarce health care resources are distributed in the country to improve outcomes.
CONCERNS
Despite the good intention of this policy in trying to increase both the number of medical beneficiaries and their access to private healthcare, SAMA is concerned about the following:
i) The lack of clear health and financial protection,
ii) The impact it will have on the doctors and the complexity of the Designated Service Provider arrangements
iii) The compromising of the principles of social solidarity, community rating and open enrolment
iv) Allocative inefficiency: Some of the treatments proposed in this package are a waste of money as they will not improve health outcomes.
v) That continuity of care is at best non-existent, and
vi) The complete lack of consultation with the public and the Doctors.
vii) The Council for Medical Schemes seeks to increase beneficiaries by recruiting those who are eligible for free health care in the public sector, instead of implementing compulsory enrolment and risk equalisation, whilst awaiting NHI implementation.
SAMA is further concerned about the lack of explicit scientific methodologies used to develop the package as well as insufficient public consultation, especially for Annexures A to E of the LCBO framework. The package is also inconsistent with current clinical practices and national policies. Misalignment with the national policies promotes fragmented and inequitable access to health care. ‘Cream-skimming’ and geographical exclusion discriminates against the sick and rural communities. The unregulated non-health expenditure further undermines health protection. In the absence of equity, efficiency, health and financial protection, there is thus no real value added to prospective beneficiaries.
Cream-skimming is when the health care package is aimed at attracting those who need health care less and will cost the scheme less. In this instance HIV and heart diseases are not covered as mandatory benefits. South Africans are more likely to die from these conditions than some of the conditions covered in the package. Those who suffer from these conditions are also less likely to purchase the package
END
About SAMA
The South African Medical Association (SAMA) is a non-statutory, professional association for public and private sector medical practitioners. Registered as an independent, non-profit Section 21 company, SAMA acts as a trade union for its public sector members and as a champion for doctors and patients.
Spokesperson
Chairperson: SAMA
Dr Mzukisi Grootboom
083 306 7779
mzukisi@mweb.co.za