The consumer commissioner has stated that medical schemes are acting in a discriminatory fashion when imposing waiting periods on pregnant women wishing to join a medical scheme during their pregnancy.
The BHF finds the Consumer commissioner's statements to be misguided and damaging to the medical schemes industry as she is not portraying an accurate picture.
Medical schemes are cooperatives where members' monies are pooled to pay for health benefits when they have been incurred by the members or when they are needed by the existing members.
To allow a new member onto a scheme when that member is about to undergo an expensive procedure, such as childbirth or a heart bypass or any other high-cost procedure would be discriminatory and unfair on the existing members, many of whom would have been paying contributions for most of their lives.
It would be against the principles on which medical schemes are governed to allow people to join a scheme at a time when they would be incurring healthcare related costs, and then allow them to leave the scheme directly after they had incurred those costs. This scenario would very quickly deplete all funds within the scheme, leaving the existing members without any cover.
Medical schemes are, by law, not permitted to make profits. The funds which make up a medical scheme are provided solely from the members' monthly contributions. Many of the 8.5 million members of medical schemes have been contributing to their funds for a number of years in order to mitigate financial ruin should they need medical attention.
Medical schemes were originally established to protect those individuals who contributed to the system and to alleviate the burden on the state. A change such as that which the Consumer Commissioner is calling for would deplete these funds and potentially bankrupt the system. This in turn would mean a greater burden on the already stressed public sector as the 8.5 current medical scheme members would have no choice but to use the public health sector.
