1. National Health Insurance
“The changing face of healthcare funding in SA”

2. Key legislative developments
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Key legislative developments
Health Market Inquiry
Competition Commission
Process started in 2014
Concerns about affordability of private health
Factors preventing competition
National Health Insurance
Political pressure to get fund established
Mega state funded medical scheme
No option to ‘opt-out’
Medical Schemes Amendment Bill
Phase 2 of NHI implementation
Legislative developments
Required to align to NHI
What it all boils down to is that once we have one thing, we try to justify why we need more. A simple example is when you start cycling : 1st you get the bicycle, then you need the gear that goes with the bicycle, the helmet, the outfit, the water bottle, etc. Once you have that, you need to join the right cycling club, etc etc etc. Another example could be when you are getting an image make over : 1st you loose the weight, then you need a whole new wardrobe, then you have to get a more modern hairstyle, and change the colour, and then you need new accessories and make-up to compliment your new look! I will take myself as an example : I am looking at getting a new puppy, so now I need to get the toys, the leash, a warm bed, a bell for her neck, etc etc etc.

3. Health Market Inquiry Findings
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Health Market Inquiry Findings
Complex set of interrelated stakeholders 1
Two-tier health system 2
Highly concentrated funders
and facilities 3
No regulation for facilities 4
Key issues:
Disempowered and uninformed members 5
Ask the members in the audience what financial freedom means to them.
Incomplete regulatory regime 6

4. FIA Submission to HMI and MSAB
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FIA Submission to HMI and MSAB
Alignment of broker interests to members 1
Annual ‘opt-in’ of broker services 2
Differentiated rate table
if not using broker services 3
Advice vs Regulatory functions 4
Key issues:
Explicit consent 5
Ask the members in the audience what financial freedom means to them.
Commercial basis 6

5. Private insurance will co-exist with NHI

6. NHI will co-exist with private health insurance
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NHI will co-exist with private health insurance
Rights of users of NHI includes the right to purchase complementary health services through a voluntary medical insurance registered in terms of the MSA or any other insurance
Ask this question to your audience, and give them a few seconds to think about it. Don’t ask them to answer you – they could feel embarrassed.

7. Someone has to make the tough decisions
The need for medical care based on:
Prognosis
Cost effectiveness
NHI refers to adherence to treatment paths and protocols

8. 10 highest member claims paid in 2017 = R48m
Age 58, Long term use of a ventilator (cardiovascular related)
205 years
R 6.0m
Age 46, Long term use of a ventilator (gastrointestinal related)
worth of contributions to fund the claim
R 5.2m
Age 26, Long term use of a ventilator (liver related)
R 4.7m
Age 53, Trauma
7 489
R 4.4m
Age 59, Trauma
individuals claimed over R
R 4.2m
Age 62, Long term use of a ventilator (infections related)
R 4.1m
Age 31, Respiratory
1 681
The Scheme cares for members with complex healthcare needs. The highest individual claim paid in 2017 amounted to R6.8m. This was for the long term use of a ventilator for a 58 year old member. This amounts to 205 years’ worth of contributions to fund the claim. “I look after you today, and tomorrow you do the same for me”. Such care spans members across all plan types, and all ages – third on the list is a 26 year-old member in hospital for over 200 days.
R 4.1m
Age 82, Infections
individuals claimed over R1 million
R 4.0m
Age 58, Complications following admission for toxicity
R 4.0m
Age 38, Long term use of a ventilator (respiratory related)
Source: Discovery Health

9. Healthcare should be rational…but reality is different
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Healthcare should be rational…but reality is different
Ask this question to your audience, and give them a few seconds to think about it. Don’t ask them to answer you – they could feel embarrassed.

10. Healthcare should be rational…but reality is different
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Healthcare should be rational…but reality is different
Ask this question to your audience, and give them a few seconds to think about it. Don’t ask them to answer you – they could feel embarrassed.

11. Healthcare should be rational…but reality is different
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Healthcare should be rational…but reality is different
Ask this question to your audience, and give them a few seconds to think about it. Don’t ask them to answer you – they could feel embarrassed.

12. Healthcare should be rational…but reality is different
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Healthcare should be rational…but reality is different
Ask this question to your audience, and give them a few seconds to think about it. Don’t ask them to answer you – they could feel embarrassed.

13. Issues for consideration
What are we solving for? 1 8
Conclusions
Regulatory timelines 2 7
What is NHI?
Roles of advice
Medical schemes vs health insurance 3
Issues for consideration 6
Issues of concern
What has not worked 4 5

14. What are we solving for? Both systems are unsustainable…
Healthcare is a microcosm of the SA experience.
The unequal society with huge gaps between the rich and the poor.
The two-tier national health system:
Public sector – overburdened and under-resourced
Private sector – exorbitant costs
Both systems are unsustainable…

15. National Health Insurance (NHI)
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National Health Insurance (NHI)
Universal coverage
Access to quality affordable health care
Based on health needs
Irrespective of socio-economic status
Free at point of access
No financial hardship for families
Ask this question to your audience, and give them a few seconds to think about it. Don’t ask them to answer you – they could feel embarrassed.

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At a point in time…
The state would the look after the unemployed and indigents Principles of social solidarity underpinned the MSA Guaranteed acceptance, community rating and limited underwriting
Medical schemes were going to be supported to increase access to care for all employed people
What it all boils down to is that once we have one thing, we try to justify why we need more. A simple example is when you start cycling : 1st you get the bicycle, then you need the gear that goes with the bicycle, the helmet, the outfit, the water bottle, etc. Once you have that, you need to join the right cycling club, etc etc etc. Another example could be when you are getting an image make over : 1st you loose the weight, then you need a whole new wardrobe, then you have to get a more modern hairstyle, and change the colour, and then you need new accessories and make-up to compliment your new look! I will take myself as an example : I am looking at getting a new puppy, so now I need to get the toys, the leash, a warm bed, a bell for her neck, etc etc etc.

17. It just is not working out!
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It just is not working out!
Ask members to give some examples of signs that show you feel ashamed or guilty. Example:
You don’t ever want to talk about money with your spouse or children
You overspend because you don’t want anyone to think you don’t have money and can’t afford things
You don’t want to get help
You don’t want to acknowledge you have a debt problem
You “brag” with your money (that you don’t actually have)
You buy the best brands (even though you can’t afford it) on credit just so your friends can think you are well-off, etc.

18. What went wrong? Poor governance Poor regulation1 6
Poor governance
Poor regulation
No mandatory cover for employed people 2 5
Inflation out of control
What went wrong?
No Risk Equalisation Fund 3 4
Demarcation debate

19. A change of course required

20. National Health Insurance Bill
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National Health Insurance Bill
Vision 1
Phases of implementation 2
Benefits 3
Access 4
Key issues:
Reimbursement for services 5
Ask the members in the audience what financial freedom means to them.
Governance 6

21. Money talks…
no definitive costs or funding mechanism provided

22. Medical Schemes Amendment Bill

23. Medical Schemes Amendment Bill?
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Medical Schemes Amendment Bill?
Governance 1
Benefits 2
Operations 3
Contributions 4
Key focus areas:
Brokers/financial advisors 5
Ask the members in the audience what financial freedom means to them.
General 6

24. Medical Schemes Amendment Bill
Areas of concern: 01 04
No waiting periods for children
Role of advice 02
Powers of the Registrar
Registrar may restrict benefits to avoid duplication with NHI 03 05
No allowance for condition specific waiting periods

25. Medical schemes are financial products

26. There are 24 open medical schemes with 179 different options to choose from

27. How does a member choose?
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How does a member choose?
Hospital benefits:
Networks
Co-payments
Deductibles
Other products:
Insurance products
Gap cover
Top-up cover
Primary care
Complex benefit structures
Day-to-day:
Savings accounts
Bank accounts
Networks
Risk benefits
Chronic illness cover:
PMB Conditions
Formularies
Networks
DSP
Just as you go to the doctor for an annual health check-up, check your financial health on a regular basis. Do an in-depth investigation to your financial habits. See how much debt you have (“measure”). Accept and acknowledge that you may have a debt problem (“get diagnosed”). Consider going for debt counselling (“prescription”), or start your own disciplined repayment plan. Start living according to a budget so that you know where your money goes to, and you can start changing your behaviour “life changes”).

28. Financial advice is key
Financial needs analysis 01
Product replacement disclosure? 05
Benefits and contributions 02
Record of advice 04
Financial advice is key
Limitation of advice 03

29. 01 05 02 04 Selection criteria 03 Benefits and rates Governance
Administration 02
Underwriting decisions 04
Selection criteria
Managed care protocols 03

30. Regulatory timeline: how soon can the Bills become law?
days
30 days
State president sign into law
National assembly accept
Provinces accept
30 days
60 days
Portfolio committee on health accept
Public consultation and portfolio committee
(health)
90 days
Minister publish draft legislation for comment
15 June - 15 September 2018
15 September - 30 November 2018
23 January - 23 March 2019
17 April - 17 May 2019
17 May - 17 June 2019
The provincial and national acceptance of the legislation will occur simultaneously with the 2019 elections
Source: National government

31. Conclusion

32. Rebirth of the Eagle… The need for change
Honesty about the obstacles we face and making the right diagnosis:
Courage to tackle the issues, difficult as they may be

33. The eagle has the longest life-span of its species
The story of the Eagle
The eagle has the longest life-span of its species
It can live up to 70 years. However, at age 40 the eagle must overcome 3 major obstacles to survive or die.

34. The story of the Eagle Psychology and Finances Obstacle 1:
It’s long and flexible talons can no longer grab prey which serves as food.

35. The story of the Eagle Psychology and Finances Obstacle 2:
Its’ long sharp beak becomes bent.

36. The story of the Eagle Obstacle 3:
Its’ old age and heavy wings, due to their thick feathers, become stuck to its chest and make it difficult to fly.

37. At age 40, the eagle is left with only two options:
The story of the Eagle
Starve and die OR
Go through a painful process of change which lasts approx. 150 days.
At age 40, the eagle is left with only two options:

38. The story of the Eagle Psychology and Finances Redress 1:
The eagle will fly to a high mountain ridge where it:
Builds a nest
Knocks its’ beak against a rock until its loose enough to be plucked it out.

39. The story of the Eagle Psychology and Finances Redress 2:
After plucking it’s beak, the eagle will wait for a ‘new’ beak to grow back and then:
pluck out its talons.

40. The story of the Eagle Psychology and Finances Redress 3:
After approx. 120 days – with both its ‘new’ beak and talons now grown back, the eagle starts the final process of its rebirth by…
plucking out its’ old-aged feathers.

41. The story of the Eagle Psychology and Finances
After five months, the eagle takes its famous flight of rebirth and lives for 30 more years.

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“There is no easy walk to freedom anywhere, and many of us will have to pass through the valley of the shadow of death again and again before we reach the mountain top of our desires. “
This saying by Madiba will ring true to any individual who has reached something in life. They will tell you it doesn’t come easy. To reach the Springbok rugby team or take part in the Olympic Games, takes years of discipline practicing, getting up in the middle of the night to exercise, watching your diet, not being able to go out with friends until late at night, because you have to be up early for a marathon, or a team practice. They will all tell you it takes discipline. And it’s the same with getting out of debt. We might have got into the debt spiral overnight by making one big financial mistake, or it happened over time because we constantly spend money we didn’t have. So to get rid of debt will take discipline, it will mean you have to sacrifice some things, but it is possible.
- Nelson Mandela

43. QUESTIONS