Our overarching objective is to advocate for a vibrant and sustainable private health sector within a well functioning and equitable health system.
Medical schemes and administrators continue to navigate an increasingly challenging environment. The population of medical scheme members has declined in real terms, driven by factors such as rising unemployment, emigration, and economic pressures. Prescribed Minimum Benefits (PMBs) are consuming an ever-larger portion of member contributions, straining the financial resources of schemes. Additionally, the industry is grappling with growing anti-selection and a significant rise in members with chronic diseases and mental health conditions. Regulatory uncertainty and an incomplete regulatory framework create additional pressures, making it difficult for schemes to plan and operate effectively.
These factors collectively underscore the need for robust advocacy, strategic interventions and a clear and unified voice to ensure the sustainability and resilience of the sector.
Strategic engagements with key policymakers are a primary focus of HFA. To this end, we enjory a constructive relationship with the CMS which has been formalised through an MOU.
Our current key focus areas include:
NHI
HFA continues to pursue a dual strategy of constructive engagement as well as a robust legal response to the NHI Act.
HFA continues to advocate for reforms that enable medical schemes to provide essential Primary Care Benefit Packages to lower income earners.
PMB Review
HFA is represented on the PMB Review Committee by two industry experts, Prof Roseanne Harris and Dr Boshoff Steenekamp.
PCR PRICING matter
During 2022, HFA submitted a complaint, on behalf of both member and non-member schemes, to the Competition Commission against Pathcare, Ampath, and Lancet, over their pricing of COVID-19 PCR tests during the pandemic in 2020 and 2021.
DTIC BLOCK EXEMPTION FOR TARIFFS
HFA continues to engage the Competition Commissioner on tariff determination in the health sector. Our focus is on supporting transparent, fair and evidence-based approaches to tariff setting that align with the Health Market Inquiry recommendations, promote value-based contracting, and address utilisation as a key driver of healthcare costs.
Fraud, Waste, Abuse and Errors (FWAE)
HFA works closely with CMS, SAMA and other key stakeholders to support transparent and fair approaches to managing FWAE, ensuring that members’ funds are safeguarded at all times.
Categorization of Assets, Regulation 30 (4) (iii) and (iv)
HFA is committed to advocating for a review of Regulation 30 (4) (iii) and (iv), which we believe could positively impact schemes’ investment income, creating a pathway to potentially reducing member contribution levels.
DSP ‘Undesirable Business Practice’ Ruling Appeal
HFA is appealing the Registrar of Medical Schemes' decision to declare certain practices regarding Designated Service Providers (DSPs) and co-payments as "undesirable."
RAF’s Directive on Payment of medical scheme member claims
HFA, and several of its member schemes supported the application by Discovery Health to compel the enforcement of the judgement compelling the RAF to pay claims while its appeal was being considered.
stakeholder engagement
As an advocacy organisation, constructive engagement with key stakeholders like the CMS, Treasury and NDoH is critical. HFA enjoys strong collaboration with the CMS under an MOU which allows for open and robust dialogue on pressing industry matters.
Several additional strategic initiatives that foster innovation, improve efficiencies and enhance the healthcare journey for medical scheme members are on HFA’s radar. These include:
HMI Recommendations and Value-Based Care (VBC):
Tariff Standardisation: HFA actively participates in an industry-wide effort to standardise coding for more streamlined billing and service tracking.
High-Cost Therapies:
Health Technology Assessment (HTA):
Establishment of a Working Group to provide day-to-day support for schemes, particularly smaller and restricted schemes.
Please email us should you require further information on our key focus areas, This email address is being protected from spambots. You need JavaScript enabled to view it..
