Who should pay for expensive life-saving drugs?

In this episode of the Maya on Money podcast, host Maya Fisher-French engages in a thought-provoking discussion with Thoneshan Naidoo, CEO of the Health Funders Association, around the complexities of medical schemes in South Africa. The episode opens with a case involving a father fighting for life-saving medication for his son, highlighting the pressing issues surrounding medical care costs and access to innovative treatments.

Thoneshan explains prescribed minimum benefits (PMBs) that medical schemes are mandated to cover, the challenges posed by outdated legislation, and the ethical dilemmas faced in healthcare funding. The conversation unpacks how medical schemes operate, how claims are funded, and the financial dynamics of risk pooling – including the implications of voluntary membership on healthcare costs.

Key topics discussed include:

- The significance of prescribed minimum benefits and their current limitations

- The ethical considerations in funding high-cost treatments versus preventative care

- The impact of an ageing population on medical scheme sustainability

- Proposals for reforming PMBs and implementing low-cost benefit options

- The future of medical schemes in the context of National Health Insurance and regulatory challenges

If you want to understand more about the complexities of medical schemes and the ongoing debates surrounding healthcare access and affordability in South Africa – this episode is really worth listening to.