DAMIAN MCHUGH | Universal cover system can be a solution to SA's healthcare crisis

SA's healthcare system faces a number of challenges, including limited resources, a high burden of disease and significant inequalities in access to care. In this context, the recent introduction of new health insurance products for the general public has brought attention to the important role that such products play in the delivery of healthcare cover in SA.

As the administrator of the largest open health insurance player in the market, Momentum Health Solutions is committed to helping provide more healthcare cover for more people. We believe in the importance of private healthcare market in the industry and we are committed to collaborating with other healthcare providers and stakeholders to improve the overall quality of healthcare in SA as we journey to universal healthcare cover.

We have seen significant growth in the health insurance segment and while numbers in this market are not public, we estimate that there are currently more than one million people covered by these solutions. This while medical schemes’ membership growth remains largely stagnant.

It is off a lower base, but it shows the increasing need for quality, affordable health insurance products for companies to provide to their employees. 

Despite the fact that roughly five to eight million employed South Africans lack access to medical aid, it's crucial to recognise that the mere introduction of health insurance products cannot adequately address the pressing healthcare crisis. It is important to note that health insurance products are not a substitute for medical scheme membership, as they do not offer the same level of cover and protection that medical schemes do.

Medical schemes are governed by legislation that requires them to pay for a basic level of care for 27 chronic conditions and 270 diseases, known as prescribed minimum benefits. Health insurance, on the other hand, is structured around more specific offerings and does not provide the same level of protection for consumers.

However, this does not mean that health insurance products are not valuable in their own right. The products already provide cover to over one million South Africans for a range of healthcare services such as dental, optical and alternative therapies. In addition, health insurance products offer more affordable premiums.

Providing more South Africans access to private healthcare is not a threat to SA’s healthcare landscape. It is important to remember that healthcare is a fundamental right for all, and as a country, we have almost nine million people on private healthcare schemes, which equates to about 15% of the population. Covering more of the uncovered population who are employed alleviates some of the pressure on a highly constrained public healthcare system.

These solutions, therefore, play a critical role in providing more affordable cover and while doing so, assist the government in their pursuit of universal healthcare. The introduction of additional health insurance products to the market may lead to a situation where those who can afford medical scheme membership opt for health insurance instead, which could place an additional burden on the public healthcare system.

This is because health insurance products are not required to provide the same level of cover as medical schemes and may not cover the cost of treatment for serious or chronic illnesses. However, if health insurance products are properly regulated and designed to complement the existing healthcare system, they can play an important role in improving access to healthcare for all South Africans.

This requires a collaborative approach between healthcare providers, insurers and government regulators to ensure that health insurance products are affordable, transparent and provide adequate cover for the most pressing healthcare needs of South Africans.

The solution to our healthcare crisis lies in the implementation of a universal cover system that enables all South Africans to access quality healthcare.

• McHugh is chief marketing officer at Momentum Health Solutions