n South African Medical Journal - Medical aid system : change way overdue : izindaba

Volume 102, Issue 3
  • ISSN : 0256-9574
  • E-ISSN: 2078-5135



The South African medical aid systemhas evolved in such a way (fragmented risk pools, legally beholden to prescribed minimum benefits (PMBs), a free-for all on provider tariffs), that there's little wonder it's adversarial and riven with antagonism, exploitation and mistrust.

These were some opinions expressed by funders and administrators in response to a KPMG medical scheme anti-fraud survey last month which found that code manipulation by service providers had increased by 51%.

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