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

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


Self-administered schemes


Self-administered schemes


Non-health Costs


Solvency


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

  • 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 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 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

  • 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 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

  • 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 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

Thank you!


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