Body, Mind, Soul,
Medical schemes are the vehicles for providing private health insurance in South Africa. Medical schemes reimburse their members for actual expenditure on health. They operate on a not-for-profit basis and are essentially mutual societies, governed under the Medical Schemes Act (Act 131 of 1998) and managed by boards of trustees. On a practical level they are guided by a number of for-profit entities that provide administration, marketing, managed care, consulting and advisory services.
Regulatory Oversight by the Council for Medical Schemes
See Legislation and Regulations, Circulars to Industry
Papers and Reports on Private Health Insurance in South Africa
The Department of Health submission to the Taylor Committee in 2002 contains a very useful history of the private health sector in South Africa and the ratinale for reforms.
• Department of Health (2002). Inquiry into the Various Social Security Aspects of the South African Health System: Policy Options for the Future. 14 May 2002.
The paper below discusses the initial response of elements of the medical scheme industry to the increased regulation under the Medical Schemes Act of 1998 and the subsequent response of the Regulator.
•McLeod, H.D., Slattery, P.G., & Van den Heever, A.M. (2001). The use and abuse of reinsurance in medical schemes. South African Actuarial Journal, 1, 95-117.
The paper below discusses the development of Prescribed Minimum Benefits and the need to extend PMBs to cover anti-retroviral treatment for HIV/AIDS.
•McLeod, H.D., Achmat, Z., & Stein, A.M. (2003). Minimum benefits for HIV / AIDS in South African medical schemes. South African Actuarial Journal, 3, 77-111.
This paper below summarises the reforms of 1998 (open enrolment, community-rating and minimum benefits) and the planned reforms (risk equalisation, income cross-subisdies and mandatory membership) for a Social Health Insurance system.
•McLeod, H. D. (2005). Mutuality and Solidarity in Healthcare in South Africa, South African Actuarial Journal, 5, 135-167.
The three papers below are an excellent introduction to private health insurance in South Africa.
• Harrison S., Bhana R., Ntuli A., editors (2007). The Role of the Private Sector within the South African Health System. In: South African Health Review 2007. Durban: Health Systems Trust; 2007.
• McIntyre D., Thiede M. (2007) Health Care Financing and Expenditure In: Harrison S., Bhana R., Ntuli A., editors. South African Health Review 2007. Durban: Health Systems Trust; 2007.
• McLeod H., Ramjee S. (2007) Medical Schemes. In: Harrison S., Bhana R., Ntuli A., editors. South African Health Review 2007. Durban: Health Systems Trust; 2007.
A major reform that was investigated extensively was the possible creation of a Low Income Medical Scheme (LIMS) environment. The reports, submissions from stakeholders and background material are very useful for researchers.
• Broomberg, J editor. (2006) Consultative Investigation into Low Income Medical Schemes. Final Report. 7 April 2006.
Click on all the sub-sections under "Low Income Medical Scheme Publications"
The policy brief below deals with common myths about medical schemes and puts hard evidence on the table to refute the myths.
• McLeod H. (2012) Myths about Medical Schemes. NHI Policy Brief 21. 5 January 2012.
Two forthcoming chapters in a book on Private Health Insurance and Medical Savings Accounts:
• McIntyre, D., & McLeod, H. (in press). Private health insurance in South Africa. In S. Thomson, E. Mossialos & R. G. Evans (Eds.), Private Health Insurance and Medical Savings Accounts: Lessons from International Experience. Cambridge: Cambridge University Press, forthcoming.
• McLeod, H., & McIntyre, D. (in press). Medical Savings Accounts in South Africa. In S. Thomson, E. Mossialos & R. G. Evans (Eds.), Private Health Insurance and Medical Savings Accounts: Lessons from International Experience. Cambridge: Cambridge University Press, forthcoming.
The policy brief below deals with possible changes to the role of private health insurance under National Health Insurance.
• McLeod, H. (2009) The Future Role of Private Health Insurance. NHI Policy Brief 7. 7 December 2009.