Discovery Health has issued a sharp rebuke to the findings of the Section 59 inquiry. It alleged the company’s systems demonstrated racial bias against black healthcare practitioners. The final report, handed to Health Minister Dr Aaron Motsoaledi, asserted that Discovery, along with Medscheme and the Government Employees Medical Scheme (Gems), employed procedurally unfair systems. These systems disproportionately penalised black professionals.…
Tag: medical aid
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Medihelp denies funding for child with Hunter Syndrome
A landmark case before the Council for Medical Schemes (CMS) has highlighted a critical conflict. This is between a medical scheme’s financial health and its obligation to fund life-saving treatment. It has left a young boy’s future in jeopardy. The appeals committee decided that the Medihelp Medical Scheme does not have to fund a vital drug for a six-year-old boy.…
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Bestmed’s Innovative AI Solution Against Fraud
Bestmed Medical Scheme, South Africa’s fourth-largest open medical scheme, is preparing to integrate Artificial Intelligence (AI) into its systems. This initiative aims to combat the growing scourge of fraudulent claims plaguing the healthcare industry. Protecting members’ funds and ensuring the scheme’s long-term sustainability amidst rising operational pressures are also goals. Bestmed CEO and Principal Officer Leo Dlamini confirmed that the…
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National Health Insurance (NHI) and Political Criticism
Mounting criticism labels South Africa’s controversial National Health Insurance (NHI) plan not as a lifeline for a broken system. Instead, critics see it as a meticulously planned manoeuvre to centralise control over a budget exceeding R1 trillion. Opponents argue that the National Health Insurance move, disguised as universal healthcare, is nothing short of “state capture 2.0.” They warn it threatens…
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HFA’s NHI Court Challenge: A Legal Perspective
The contentious National Health Insurance (NHI) Act again faces court action, with HFA’s NHI court challenge marking its sixth legal challenge. This time, HFA’s NHI court challenge is brought by the Health Funders Association (HFA). The HFA represents a significant portion of South Africa’s medical scheme industry, including Discovery Health Medical Scheme. It has formally petitioned the court to declare…
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Private Hospitals Brace for Muted Growth Amid Economic Squeeze
LEADING analysts are cautious about the growth trajectory for South Africa’s private hospital sector. They cite stagnant medical aid membership figures, a declining healthcare workforce, and a persistently challenging macroeconomic environment as key headwinds. This week, Netcare and Life Healthcare, two of the nation’s largest private hospital groups, reported earnings growth for the six months ending in March. However, Netcare…
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Medical Scheme Solvency Issues Impacting Members
Three medical aid schemes – Medihelp, Sizwe Hosmed Medical Scheme, and Transmed Medical Fund – did not maintain their medical scheme solvency ratios at or above the statutory minimum of 25% in 2023. This was a key finding in the Council for Medical Schemes (CMS) Financial Performance Industry Report 2023, released last week. While the total number of medical aid…
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Rising medical costs: A warning shot for SA consumers
As South Africa’s healthcare costs continue to rise, open medical schemes have announced their contribution increases for 2025. Bestmed, Fedhealth, and Medihelp lead the pack with weighted average increases of 12.75%, 12.4%, and 10.8%, respectively. Other top schemes, such as Bonitas (10.2%), Momentum (9.4%), and Discovery (9.3%), follow closely behind. According to medical scheme administrators, several factors contribute to these…