The Council for Medical Schemes (CMS) has officially released its CMS Industry Report 2024. This document offers the first fully integrated review of the sector since 2022. It merges critical data on healthcare utilisation with a comprehensive financial assessment. The findings paint a picture of an industry under significant strain. Key pressures include demographic shifts, soaring hospital costs, and a…
Tag: Medical Schemes
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Illegal weight loss injections: The rising black market crisis
The quest for rapid weight loss in South Africa has birthed a dangerous shadow economy. For many, acquiring potent GLP-1 agonists no longer requires a clinical consultation. Instead, it involves a few WhatsApp messages and a payment to a stranger. This burgeoning trade in illegal weight loss injections highlights a desperate intersection of public health needs and economic barriers. As…
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NHI Funding Plan “Unworkable and Unfeasible,” warns HFA
South Africa’s ambitious National Health Insurance (NHI) plan is facing intense scrutiny. The Health Funders Association (HFA) warns that “uncertainty and contradictions” plague the government’s NHI funding plan. They render it “unworkable and unfeasible”. The HFA has raised fundamental questions about the affordability and sequencing of the NHI. They highlight contradictory timelines presented by the Department of Health in court…
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‘Mega Gap Claims’ Explode by 512% as Medical Aid Shortfalls Soar
South African medical scheme members are facing an unprecedented financial crisis, as new data reveals that “mega” out-of-pocket gap claims have exploded by 512% in just four years. This alarming trend highlights the soaring medical aid shortfalls patients are forced to pay, driven by specialists charging up to 500% of scheme rates and medical aids systematically reducing benefits. The data,…
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Medical Tax Credits Under Investigation by Treasury
The National Treasury confirmed that it is actively investigating the “number of potential implications” of limiting or entirely removing medical tax credits. Proponents have long proposed this move as a key mechanism for raising funds for the government’s sweeping National Health Insurance (NHI) scheme. In a brief statement, the Treasury acknowledged it “had engagements with the Health Department” on the…
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BHF Seeks Clarity for Medical Tax Credit Changes
The Board of Healthcare Funders (BHF) has written to Treasury director-general Duncan Pieterse, demanding “urgent clarity” on the government’s plans to phase out medical scheme tax credits. These credits serve as a financing mechanism for the National Health Insurance (NHI), a controversial initiative. In light of this, BHF seeks clarity on how these changes will impact the healthcare funding landscape.…
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NHI Legal Challenge: A Constitutional Crisis Ahead
Since President Cyril Ramaphosa signed the controversial National Health Insurance (NHI) Act into law in May 2024, a legal storm has erupted. At least eight different groups have filed court applications to challenge the Act, with many arguing it is unconstitutional. A core argument uniting these legal challenges is that the NHI, rather than expanding healthcare, will lead to fewer…
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New NHI Taxes Timeline Suggests Delay Until 2033
The government may not need to introduce new taxes to finance the National Health Insurance (NHI) scheme for another decade. This is according to a presentation by the Department of Health to Parliament. The department’s deputy director-general for NHI, Nicholas Crisp, sketched a 15-year phased funding model. This suggests that new tax levies would only commence around 2033/34. New NHI…
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Bonitas Medical Scheme Faces Procurement Rigging Claims
Bonitas Medical Scheme, one of South Africa’s largest medical aids, manages a R20 billion fund. It is facing explosive allegations of systemic capture following the emergence of a new whistleblower report. A flash drive containing emails, draft contracts, and internal communications allegedly reveals a concerted effort. Senior executives, trustees, and favoured consultants aimed to rig procurement processes and redirect lucrative…
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Private Healthcare Market Dominance Reveals Serious Problems
A new report reveals a troubling reality. A small group of private hospitals and medical schemes are earning huge profits. This is due to their ongoing market dominance. The advocacy group Open Secrets states that a lack of regulation is a key factor in this issue. Six years ago, the Competition Commission raised similar concerns. However, very little has changed…
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Mediscor Medicines Review 2024: Key Insights Revealed
The Mediscor Medicines Review 2024 reveals a significant 5.0% increase in medicine expenditure. This marks the most substantial rise in the past three years, presenting a complex challenge for South Africa’s healthcare sector. As a leading pharmaceutical benefits management (PBM) organisation covering over 2.6 million lives, Mediscor’s annual analysis provides a critical barometer for the industry. The 2024 report highlights…