There are still many issues to be clarified in terms of providing sustainable cover for low income earners, not least the pre-proposed low cost benefit options (LCBOs).

In answer to a question in this regard in light of the tough economic situation in which many South Africans are starting to find themselves due largely to COVID-induced constraints, Dr Sipho Kabane, Council for Medical Schemes (CMS) CEO and registrar, told BHF Dialogue Session webinar participants this week that discussions around LCBOs and related options were “at a delicate stage” at the moment.

“There are a whole host of issues that still have to be clarified but I don’t believe that the low cost benefit options will be the solution by themselves,” said Kabane.

“I think we have to look at the landscape to see what’s already available such as primary insurance products – products, for example, with benefits so thin with costs that are not sustainable. I believe there must be radical change to improve the benefits that are sitting there so that policy holders can benefit at a sustainable cost.”

The ultimate aim, according to Kabane, must be the already proposed single low cost option across all schemes: “We need to be driving those primary insurance products and all the offerings targeted at low income earners already sitting in the schemes environment towards a comprehensive single option as recommended, for example, by the Health Market Inquiry (HMI) panellists.

“When we have that standardised option where we can migrate insurance products and other low income targeted products, we can use that as a basis to fit into the schemes environment to ensure that we cover more people in a sustainable system.”

Speaking generally on issues surrounding the COVID response and experiences, Kabane acknowledged that the situation would have been better managed and co-ordinated had some of the HMI recommendations already been implemented. Examples, he said, were tariff negotiations which would have assisted in bringing down the costs of, for example, PPEs, as well as telemedicine tariffs.

“Joint planning with the industry we regulate in terms of identifying risks of this nature – a concerted, co-ordinated effort to be able to anticipate rare and unexpected possible risks – must now take place.”

On this point Kabane noted that the CMS was hoping to entrench disaster-based minimum benefits which would “kick-in immediately with a disaster of this nature”.