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Curetted medical scheme seeks young blood

By unknown | Nov 26, 2007 | COMMENTS [ 0 ]

Xolile Bhengu

Xolile Bhengu

A medical scheme which has been under curatorship since March is planning a massive expansion of its ageing membership to minimise risk.

The Council for Medical Schemes (CMS) took Pro Sano to the Cape High Court, recommending it be curetted, after several governance irregularity findings. The chief executive had already resigned and the board of trustees was dissolved.

The court-appointed curator, Joe Seoloane, found the scheme's 14 trustees had, over three years, spent more than R17 million on advertising and marketing without any net gain, confirming previous auditor findings of mismanagement, bitter infighting and litigation among trustees.

Seoloane also discovered payments of a capitation fee of R1,6 million made to (then unaccredited) managed care provider Primed.

Three-decade-old Pro Sano, which has a predominantly 60 percent Western Cape based membership, said it planned to broaden and balance the risk of its 32 000 membership, whose average age is 54.

The scheme's clinical operations executive, James Arens, said the scheme would target the 35-45 year-old age group but would not limit younger or older membership requests.

"We are going in hard and our main target provinces are the Eastern Cape, KwaZulu-Natal and Gauteng."

Arens said curatorship was not the same as liquidation, adding that the curatorship had improved staff morale and general running of the business.

The scheme membership ranges from government, state-owned enterprises, companies and individuals. The CMS annual report in 2000 had the scheme membership at about 47 000 (or 131 608, including beneficiaries), but Pro Sano today has about 90 000 members, including beneficiaries.

CMS strategy specialist Stephen Harrison said it was key for a curetted scheme to gain new membership to improve risk and finances.

He said the curator would hand over Pro Sano to a newly elected board, once satisfied with management and financial stability.

He said: "We are in constant contact with the curator, and, to date, we are happy with (Pro Sano's) progress."


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