Circular 13 of 2023: Update on the status of the development of LCBO Guidelines

Purpose
This circular aims to provide an update on the status of the LCBO development guidelines and to provide indicative timelines for finalisation and submission to the Minister of Health for consideration and approval.

Background
The concept of benefit options targeted at low-income earners dates back over two decades. In 2001, the Centre for Actuarial Research (CARe) of the University of Cape Town conducted a study titled “Low-Cost Options in Medical Schemes, the Need for Low-Cost Options, and an Analysis of Benefit Designs” which was supported by the Council for Medical Schemes (CMS). The study recommended that the next generation of low-cost benefit option designs should consider the following:
• Hospitalisation is offered in differential amenities in a public hospital.
• Specialist services in a public hospital.
• Primary care providers offer chronic medicine in public hospitals or with a strict formulary.
• Primary care is offered in private sector capitated networks.

The study further recommended contributions for a family of four earning less than R4 000 per month to be in the order of R500 per month, or lower, to satisfy the goal of affordable healthcare.

Download the full Circular here.