Public Hearings 2 March 2016 The Unlimited amp HCPs Competition Commission Health Market Inquiry Direct marketer of insurance and noninsurance products Majority of customers have hospital cash plans ID: 513347
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Slide1
Competition Commission: Health Market InquiryPublic Hearings2 March 2016Slide2
The Unlimited & HCP’sCompetition Commission: Health Market Inquiry
Direct marketer of insurance and non-insurance products
Majority of customers have ‘hospital cash’ plans (
HCP’s
)
HCP’s:
Cover
contingent liabilities
whilst hospitalised
Benefits:
Not paid
to service
providers
Not d
etermined
by reference to
medical expenses
Used
for contingent liabilities and medical bills
Private healthcare expenditure:
medical schemes = 81.2
%
(about
R 98.1 billion
)
insurance
products and
employers = 3.8
%
(R
4.6 billion
)Slide3
Draft Demarcation RegulationsCompetition Commission: Health Market Inquiry
Health insurance products regarded as a threat to medical schemes: draw young, healthy
people
out of schemes leading to rising costs for older/sicker members. Cross-subsidisation key to improving affordability
HCP’s catered
for → ‘
Non-medical expense cover as a result of hospitalisation
’
Cover capped: R 3000 per day
Less than 20% of population has medical
aid – health insurance or
State facilities
are the only options
HCP’s
don’t pose a threat to medical schemes
→
scheme contributions unaffordable
W
hy cap benefits?Slide4
Right to Health CareCompetition Commission: Health Market Inquiry
Right
to health
care services =
a socio-economic
right
State has
obligation not to
interfere unjustifiably with socio-economic rights
A law
which leads to a decline
in
conditions to
which SE rights pertain = infringement
Regulations will restrict ability for people who rely on insurance products
to cover
medical
costs and contingent liabilities
No
evidence
that health insurance products affect viability of medical schemes. 2008 decision of SCA
Imposing limit on HCP’s does not address
the issues associated with the affordability of medical schemes + LCBO’s on holdSlide5
Constitutional Rights contd.Competition Commission: Health Market Inquiry
By limiting / preventing insurers
from offering health insurance products, only
cover available may be
medical
aid – but costs exceed
a R110 a month or so
HCP and out of reach for most
Regulations indirectly discriminate
against low-income individuals in contravention of section 9 – will have a
disproportionate impact on such groups
Regulations not
rationally connected to their
purpose – will exclude mechanisms
for low-income earners
to provide for health care needs,
increasing
exposure
to financial
and
health
risksSlide6
Going ForwardCompetition Commission: Health Market Inquiry
Urge Treasury to await
outcome
of Inquiry
before finalising Regulations
Inquiry may
be moot at least insofar as health insurance policies
affected by the
Regulations is
concerned
National
Health Department’s ‘Patients Rights Charter’: every patient has “
a right to: insurance
”.
TCF Outcome 2:
Products
and services marketed and sold in the retail market are designed to meet the needs of identified customer groups and are targeted
accordingly. Talks to:
Responsible
marketing of health insurance
Products
must
be appropriate to target
market – benefit caps?Slide7
Thank you