BHF comments on doctors' confidence survey

It believes that it is of utmost importance that funders and providers work together, to appreciate their mutual working environments. Reacting to the decrease in dental benefits by medical schemes, the BHF believes that legislative imperatives and systemic inconsistencies are often to blame in the cost spiral being experienced by medical schemes and their members, which in some instances results in decreasing of benefits.

The legislative challenges include the absence of a regulated tariff and legislation around PMBs, which force medical schemes to cover a set of high cost interventions in full and at whatever cost the healthcare provider charges.

The systemic problems, such as the fee for service payment model, contribute to the misalignment of incentives between funders and providers and add significantly to costs. These also enable over-servicing, fraud and wastage, thereby threatening the quality of care within the sector.

As is the case with most health systems around the world, balancing contributions from members with claims received sometimes results in unpopular funding decisions, especially as current South African legislation favours a hospi-centric approach to funding rather than a primary care approach.

"Funders and providers depend on each other for their survival, therefore, it is very important that we begin to align the incentives between the two in the interest of the member, instead of inflaming what is often an extremely volatile relationship," says Dr Zokufa, MD of BHF.

In its submission to the NHI Green Paper, the BHF suggests a 'Gautrain' model, where the private healthcare sector expertise and skills are utilised to realise the policy of government. This model requires total buy-in from funders (including administrators and managed care entities) and providers of service to be successful.

The Board of Healthcare Funders of Southern Africa (BHF) is the representative body for the majority of medical schemes and members throughout South Africa, Lesotho, Namibia, Botswana and Zimbabwe.