Legislative review of Parmed: briefing

Ad Hoc Committee on Parliament and Provincial Medical Aid Scheme

22 August 2018
Chairperson: Mr M Parkies (ANC)
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Meeting Summary

The Ad Hoc Joint Committee on Parliament and Provincial Medical Aid Scheme was supposed to be briefed by the Office of the Chief Justice – the Office informed the Chairperson that it was unable to deliver the presentation today.

Members discussed the possible need to reduce the size of the Committee to ensure that having a quorum was not a challenge in the Committee taking decisions when required, especially because if the Committee  continues at the slow pace that it is running at currently it will not be able discharge the responsibilities that it is set to do. Parliamentary staff were asked to look into this possibility. Others Members suggested the composition of a subcommittee of at least one Member from each party to carry the bulk of the work the Committee is meant to do.

The Committee then discussed its report emanating from a workshop held by the management committee on 13 June 2018. Members were pleased with the content of the report but suggested it include recommendations and concrete action steps to inform how the Committee would move forward. There was discussion on the need to invite various medical aid providers to make presentations before the Committee for Members to decide on which options were best. This raised questions on whether Parmed was compulsory or not. There were also questions on whether the Committee should be in contact with the Competition Commission and Department of Health in the context of the National Health Insurance.

Members then deliberated on its approach to hearing submissions. While it does not fall within the ambit of the Committee to adjudicate the submissions, the Committee can however hear these submissions. It was said the Committee was for formed to listen to submission of political parties. It was suggested submissions be sent to the subcommittee and the Committee can then look at the feasibility thereof. It was also suggested experts assist Members. The suggestion of the subcommittee was countered to ensure all Members heard the submissions. The subcommittee could consolidate the submissions. 

It was decided Parmed should make a presentation to the Committee. A subcommittee would be set up. The next meeting of the Committee must be convened as a product of constructive engagement between the office of the two Co-Chairpersons and the secretariat including all legal and content advisor – in this way, when the Committee next convenes, it will have something concrete to deliberate.

Meeting report

Apologies and Agenda

Apologies were received from Co-Chairperson Ms L Maseko (ANC), Ms Z Ncitha (ANC), Mr E Mlambo (ANC) and Mr S Marais (DA).

 

The Chairperson asked Members to adopt the agenda for the day.

There was a problem with adopting the agenda because the Committee was not qourate.

The Chairperson expressed his concern over the size of the Committee which he said was too big. The Committee was dealing with an important and urgent matter and its size could inhibit the Committee making important decisions.

Adv. Mongana Tau, Parliamentary Legal Adviser, informed the Committee that it can deliberate on the agenda without having a quorum as long as it did not take any decisions.

Ms T Mokwele (EFF) said that letters should be written to whips of political parties about the absence of Members without formal apologies.

Ms S Kaylan (DA) suggested the Committee writes to the Chair of Committees to be given permission to have a meeting during the many plenaries happening in the fourth term. That way, Members cannot say they cannot be present at the meeting because of other meetings they have to attend. With the current number of seven of the 22 Committee Members present, the Committee cannot be sure if the Members not present will not disagree with decisions that the Committee would have made which would mean the process would have to started all over again.

The Chairperson suggested that the size of the Committee be reduced because even if other Members arrive to the meeting, the experience itself is enough to signal the need to cut down on the number of Committee Members. If the Committee continues at the slow pace that it is running at currently it will not be able discharge the responsibilities that it is set to do. He asked the legal advisor about the possibility of doing that.

The legal advisor said he would inquire about the possibility of the Chairperson’s request.

Mr M Khawula (IFP) objected to the idea of reducing the size of the Committee because it would affect representative proportions unless the Chairperson would sacrifice some ANC Members as it has bigger numbers. He also noted that when letters are being written to the political parties, it must be specific about Members that are not attending and not generalise as other Members actually do go to meetings as they are required to do.

The Chair said that an objective decision would be taken because this is a matter that affects everyone irrespective of the political party they are in.

Mr N Singh (IFP) said that the size of the Committee is governed by the Joint Rules. There is however nothing stopping the Committee from forming a subcommittee of at least one Member from each party to carry the bulk of the work the Committee is meant to do - that way there will not be any hold back from doing things like listening to presentations because of not having enough Members in the meeting.

Dr S Thembekwayo (EFF) said that Members should indicate whether they will be able to attend prior to the meeting because the Committee has now already spent about 35 minutes talking about attendance.

The Chairperson suggested the Committee create a WhatsApp group so that Members can communicate easily on attendance - not everyone is able to look at their emails constantly to confirm meetings. A WhatsApp group allows for Members to easily communicate without any inconvenience.

Ms C Dudley (ACDP) suggested that parties have someone on standby should there be a case of a Member unable to attend - she herself is not a Member of the Committee but she was asked to fill in for a Member of her party. Perhaps if parties have people on standby there will not be issues of attendance.

Ms Kaylan asked if it was possible to ask for an extension on the report that is supposed to be submitted by the Committee on the medical aid scheme.

The Chairperson asked if the Committee could use one or two days of the next recess because next year’s programme is tight due to elections.

Ms G Oliphant (ANC) also suggested the Committee have meetings a week after recess on a Tuesday and Wednesday so that it can cover more work.

Other Members of the Committee arrived, a quorum was formed and the agenda was adopted.

The Chairperson read the agenda to the Committee.

Dr Thembekwayo noted the agenda being read was different to the one she received prior to the meeting. She asked the Chair to justify the change of programme.

The Chairperson replied that he sent a message to administrators to inform Members that the agenda was changed. The main reason for the change of agenda was because the Office of the Chief Justice did not respond in time - it only responded the previous day informing the Chairperson that it was unable to deliver the presentation it was supposed to today.

Workshop held 13 June 2018

The Chairperson was part of a management committee briefing session where it was agreed that Members of the Committee should have a copy of the report that emanated from the workshop. The workshop itself was a success. Content-wise it was sufficient despite the absence of some Members of the legislature that were supposed to be in attendance. He opened the discussion by asking how Members felt about the workshop.

 

Dr Thembekwayo expressed that for there to be sufficient engagement on documents, they should have been sent in advance so that Members have enough time to read and critique the reports.

Mr Singh received the reports a couple of days prior to the meeting. He read through it and thought it encapsulated what happened in the workshop. There are however certain actions steps that cannot wait for a meeting to be talked about - Parmed could be asked whether there are other packages that it could offer, it could be asked about its admin fees, which are extremely high in comparison to other medical aids, there was also the need to discuss magistrates - none of these have been responded to. There also needs to be a meeting for drafters of the Bill so that they can tease out the constitutionality of things that the Committee has agreed on. The Committee would make more informed decisions moving forward.  The question of remuneration is a good place to start. There is also a need for input from retired Members –these are some of the issues the Committee has to deal with in this meeting.

Ms Kaylan shared the sentiments expressed by Mr Singh - she said the report did not have any action plans accompanying it, no timeframe and no clarity on who is going to be doing what. Other than this it is a good report. She was also concerned as to why the 2015 report was included in these documents.

Mr Khawula gave attention to the affordability report because it highlights some recommendations of the things that can be done going forward. Perhaps looking into that report could be delegated to the subcommittee.

The Chairperson asked Members whether they thought it would be helpful to be in contact with the Competition Commission and the Department of Health in the context of the National Health Insurance that talks to universal coverage.

Dr C Mudler (FF+) did not think the Committee should concern itself with those issues. The Committee is pressed for time and next year is an election year so the Committee should just focus on what it is set to do - whatever government has in mind regarding the national health scheme does not concern the Committee.

Ms Oliphant wanted to find out about the feasibility of having other medical aids doing presentations so that the Committee can draw conclusions on what option is the best.

Mr S Tleane (ANC) expressed his satisfaction with the assessment report of the previous workshop. It is impossible to talk about the assessment of the previous workshop without looking at the way forward for the proposed programme. The report indicates there is a desire to meet with the Institute of Magistrates - it also talks about the possibility of including councillors in Parmed so that there are a bigger number of people registered under it to decrease costs. Presentations will assist in gaining a better understanding of how everything is going work. The secretariat should set out key issues that need to be engaged in the next step which should comprise the agenda for the next meeting of the Committee. The next meeting must have a strategy report that focuses on the main issues so that there can be progress. With very little time, the few meetings of the Committee will have to be used wisely because elections take away a lot of time.

Ms B Dambuza (ANC), replying to the Chairperson’s question on inclusion of the Competition Commission and the Department of Health, noted that in the last meeting the concern was raised regarding the Medical Aid Act - it was stated an amendment to this Act would affect the functioning of Parmed, so perhaps a briefing from the Department of Health would helpful in finding out if Parmed will be affected and if it is, to what extent. The Competition Commission should be also be called so it could provide expertise.

Engagement on submissions

The Chairperson stated that there needs to be an agreed upon approach on how submissions are going to be handled. For example, there is a submission from the EFF and from a Member of the DA who is hospitalised and being treated with acupuncture - this form of treatment is not covered by medical aid. Essentially, in the policy making process, one picks up gaps that need to be filled - this policy must account for those missing spaces. Another submission was from the Magistrate Commission. The Chairperson asked the Committee to agree on the approach to take in dealing with submissions. The Committee should also take ownership of the report emanating from the workshop, especially since the workshop was an idea of the Committee.

Mr Singh agreed insofar as the report stating what happened in the workshop. He wants the report to go further and include recommendations to be implemented moving forward. The Committee is a political one that should not concern itself with things that other bodies can do. There are Members of the Committee serving on the Parmed board where all possible complaints about the unacceptable behaviour of Parmed can be lodged.

Dr Mulder noted that while he does not serve on the Parmed board but his colleague does.

Ms Kaylin expressed that when the Committee was formed, political parties were asked to make submissions. While it does not fall within the ambit of the Committee to adjudicate the submissions, the Committee can however hear these submissions.

Ms Dudley pleaded that the Committee does not go into hearings and just rather look into the feasibility of continuing with Parmed.

Ms Oliphant agreed stating that Parmed will never be neutral when making these kinds of presentations.

Dr Thembekwayo stated that as a Member of the EFF, she was sent by her party to make submissions on their complaints about Parmed – that is the reason why the Committee was formed, for it to listen to submission of political parties.

The Chairperson emphasised the importance of making a decision on the approach the Committee would take when dealing with submissions. There must be a mechanism on how the Committee would deal with submissions.

Mr Tleane suggested that submission be sent to the subcommittee. The Committee should then look at the feasibility of the submissions. When doing so, there should be experts that are going to assist with the legalese of the policy.

Ms M Dikgale (ANC) expressed her disagreement as she believed the subcommittees will take long a time. The presentation of the submissions should be done so that the Committee could hear them - this would also broaden the Committee’s thinking as it will be apparent as to which matters should be discussed by the Committee and which matters fall within the competence of the Parmed board.

The Chairperson commented on the submission of the EFF stating that it addressed some of the matters the Committee was dealing with. He asked Dr Thembekwayo if it possible for her to make her submission immediately. The subcommittee would consolidate the submission at a later stage.

Dr Thembekwayo could not present the submission because she would need 30 minutes to make a detailed submission on behalf of the EFF.

The Chairperson said this was unfortunate as there was not enough time left to allow the EFF to make its submission.

Ms Oliphant expressed that whenever the subcommittee has a meeting there should be legal advisors that will advise it. Different medical aid providers should present what they could offer.  Parmed was not happy when other medical aids were making presentations in the workshop. There should be different medical aids competing so that the Committee can decide which works best.

The Chairperson said it was already agreed upon that Parmed will be the medical aid to make a presentation.

Mr M Shelembe (NFP) expressed a bit of confusion with the objectives of the Committee because Parmed is compulsory. If there are proposals from different service providers what will happen to the current statute that makes Parmed compulsory?

The Chairperson confirmed that Parmed is compulsory until the Committee takes a decision where there would be amendment of the Act that makes such a change in policy legally possible. Anything that does not benefit should be tempered with. The Chairperson expressed that he paid R14 000 for his medical aid because he had to take out cover over a large number of family members. If Parmed is not working then it should be changed.

Mr Singh stated that the Member of the EFF should be given time to make her submission. The EFF should be afforded the time sooner than later because it has a court case on the same matter but have suspended proceedings waiting on the outcomes of this Committee. Were Members legally obliged to use Parmed? If the answer is no there is no reason why the Committee could not look at other providers. Members could then decide for themselves which medical cover they preferred and maybe Parliament could possibly subsidise it.

The Chairperson summarised the meeting: the first decision taken is that Parmed should make a presentation. The Committee would have to convince and persuade the SA Local Government Association (SALGA) to be part of this process. There was an agreement that the subcommittee will still be presided over by the Co-Chairpersons. As much the Committee understands the importance of recess, there is an agreement that the Committee will meet to further discuss some matters that are still contentious and allow for presentation of submissions. There has also been an agreement that the will be a resolution in the House to reduce the size of the Committee to have a reduced membership.

Mr Tleane expressed that at present, the Committee should not be concern about numbers as there has just been establishment of a subcommittee. He further reiterated a point he made earlier about how the next meeting must be convened as a product of constructive engagement between the office of the two Co-Chairpersons and the secretariat including all legal and content advisor – in this way, when the Committee next convenes, it will have something concrete to deliberate.

The meeting was adjourned.

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