Thesis (MBA)--Stellenbosch University, 2007. / ENGLISH ABSTRACT: This study provides an overview of the medical aid industry in South Africa and highlights the
impact of the formation of the Council for Medical Schemes through the implementation of the
Medical Schemes Act of 1998. The regulatory framework that governs the medical aids in South
Africa is analysed.
In this study. different medical aid funds are compared in terms of administration costs, required
solvency levels and membership numbers relative to the acceptable industry averages. The main
cost drivers of medical aid funds that could also threaten the future of private medical care are
identified, as these services may not be affordable to most South Africans in the future.
The new vision of government in terms of healthcare is outlined, and the regulations that will be
implemented to transform the healthcare sector into a Social Health Insurance system, and
ultimately into a National Health Insurance system. are analysed. The proposed mechanisms,
such as the Risk Equalisation Fund, the Government Employees Medical Scheme and lowincome
medical schemes, are discussed, highlighting all their advantages as well as the
associated risks for the sustainability of private medical care.
The proposed new legislation and the potential negative financial impact on the private medical
industry are analysed with detailed reference to the Medical Schemes Act of 1998 and the
Medicines and Related Substance Control and Amendment Act of 1997. The implications of
fundamental changes proposed in private health insurance, such as community risk rating versus
the traditional individual risk rating, are discussed. The negative impact of prescribed minimum
benefits (which include HIV/Aids) on the financial sustainability of the medical aid industry is
highlighted.
The impact of HIV/Aids on the sustainability of the medical aid industry is discussed and some
conclusions and recommendations are made regarding the financial sustainability of the medical
aid industry and hence the future of private medical care in South Africa. / AFRIKAANSE OPSOMMING: Hierdie studie is 'n oorsig van die mediesefondsbedryf in Suid·Afrika, en beklemtoon die impak
van die totstandkoming van die Raad van Mediese Skemas deur die impJementering van die Wet
op Mediese Skemas van 1998. Hierdie regulatoriese raamwerk, wat mediese fondse in SuidAfrika
tans reguleer, word in die studie ondersoek.
In hierdie studie word van die grootste mediese fondse in tenne van administratiewe koste,
voorgeskrewe fondsreserwes en lidmaatskapgetalle relatief tot die aanvaarde bedryfsnonne met
rnekaar vergelyk. Die belangrikste koste-items vir mediese fondse wat die voortbestaan van
privaat gesondheidsorg kao bedreig, word ontleed cmdat hierdie dienste in die toekoms vir die
rneeste Suid-Afrikaners onbekostigbaar kan word.
Die regering se nuwe visie vir gesondheidsorg word uiteengesit. asook die regulasies wat
germplementeer sal word om die gesondheidsektor na 'n sosiale gesondheidsversekeringstelsel
en uiteindelik na tn nasionale gesondheidstelsel te transfonneer. Die voorgestelde meganismes,
seos die Risiko-egalisasiefonds, GEMS en laeinkomste-mediesefondse word bespreek, met al die
relevante voor- en nadele, tesame met die geassosieerde risiko's vir die voortbestaan van privaat
mediese dienste.
Die voorgestelde wetgewing en die gevolglike negatiewe finansiele impak op die privaat
gesondheidsbedryf, met spesifieke verwysing na die Wet op Mediese Skemas van 1998 asook
die Wet op die Beheer van Medisyne en Verwante Middels van 1997, word ondersoek. Die
implikasies van fundamentele veranderinge wat in terme van gesondheidsversekering voorgestel
word, soos gemeenskapsrisikogradering teenoor individuelerisikogradering, word bespreek.
Voorgeskrewe minimum voordele (wat MIV insluit) wat nou ingevolge wetgewing ten volle
deur fondse betaal moet word, se potensiele negatiewe impak op die finansiele
lewensvatbaarheid van mediese fondse word beklemtoon.
Die potensiele negatiewe impak van die MIV-epidemie op die lewensvatbaarheid van die
mediesefondsbedryf word bespreek en gevolg deur aanbevelings om die fmansiele
lewensvatbaarheid en toekoms van die privaat gesondheidsbedryf in Suid-Afrika te verseker.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/21186 |
| Date | 12 1900 |
| Creators | Loubser, Petrus Abel |
| Contributors | Roux, Andre, Stellenbosch University. Faculty of Economic and Management Sciences. Graduate School of Business. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | Unknown |
| Type | Thesis |
| Rights | Stellenbosch University |
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