The future of medical schemes is in your hands
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The future of medical schemes is in your hands. Dr Monwabisi Gantsho CEO Council for Medical Schemes and Registrar medical schemes. Contents. Consolidation Self-administered schemes Member activism Amendments to the MSA. Consolidation. Consolidation. Consolidation. Consolidation.

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The future of medical schemes is in your hands

The future of medical schemes is in your hands

Dr Monwabisi Gantsho

CEO Council for Medical Schemes and Registrar medical schemes


Contents

Contents

Consolidation

Self-administered schemes

Member activism

Amendments to the MSA


Consolidation

Consolidation


Consolidation1

Consolidation


Consolidation2

Consolidation


Consolidation3

Consolidation


Self administered schemes

Self-administered schemes


Self administered schemes1

Self-administered schemes


Non health costs

Non-health Costs


Solvency

Solvency


Diverse role players common in sa and universally

Diverse Role players common in SA and universally

Industry

Healthcare

Professionals

University and Researchcenters

‘Stakeholders’ or partners

Policy makers(HPC institutions)

Patients

Policy makers(Provinces/MemberStates)

Competentauthorities(Administrations)

When You Run Alone, You Run Fast. When You Run Together, You Run Far.


Medical scheme member activism

Medical scheme member activism

  • Member activism refers to general population, specifically potential patients.

  • In medical aid industry means co-owners of medical schemes.

  • Includes proactive and reactive participation in governance structures.

  • Attend and hold trustees accountable (AGMs, SGMs and Complaints).


Medical scheme member activism1

Medical scheme member activism

  • ‘Lack of attendance at AGMs - sign of member happiness’.

  • General Meetings have become arenas for expression of unhappiness over governance:

    • Medical Scheme A: > 7 000 principal members, only 13 attendsAGM

    • Medical Scheme B: > 70 000 principal members, no quorum

    • Medical Scheme C: > 77 000 principal members, > 90% of persons present are invited employees of service providers contracted to the scheme and employees of the medical scheme .

      (Source: CMS AGM and SGM Monitoring Reports 2011/2012)


Medical scheme member activism2

Medical scheme member activism

  • Member complaints another form of member activism, remains vibrant:

    • Medical Scheme A attendance = 13 membersv 54 complaints in the year preceding AGM

    • Medical Scheme B attendance = Nil membersv 106 complaints in the year preceding AGM

    • Medical Scheme C attendance = 180 members v 161 complaints in the year preceding AGM

      Source: CMS Complaints Register 2011/2012).

  • Member activism currently characterised by reaction and little, if any, prospective participation.


Engendering activism the challenges

Engendering Activism: The Challenges

  • Primary challenge: South Africa at infancy.

  • Level of financial literacy still renders meaningful engagement with management of medical schemes an arcane science.

  • Lack of access to full details of conduct of trustees.

  • Time for media coverage reporting on state of the industry activism?


Medical schemes amendment bill

Medical Schemes Amendment Bill


Medical schemes amendment bill1

Medical Schemes Amendment Bill


Medical schemes amendment bill2

Medical Schemes Amendment Bill

Changes with a large impact:

  • Improved information management

  • New Chapters relating to membership

  • PMB’s/MMB’s

  • Complaints procedures

  • Appeals procedure

  • Governance provisions


Mac campaign

MAC Campaign

  • In April 2013 CMS launched a campaign encouraging members to attend their AGMs.

  • A billboard was published and appeared on the N1 highway for 3 months.

  • Radio advertisements ran for a week on national radio nations in April.


Mac campaign1

MAC Campaign

  • Members were invited to enter the competition which will end at 31 August when most schemes will have had their AGMs.

  • The criteria include physical attendance of the scheme’s AGM and valid membership of the relevant scheme.

  • The first prize is payment of three months of the membership fee.

  • Many schemes participated and promoted the competition to their members.


Conclusion

Conclusion

Thank you!


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