Parliament, Thursday, 26 March 2026 – The Portfolio Committee on Health has expressed its dissatisfaction with the delays in implementing the recommendations of the Health Market Inquiry (HMI) report , seven years after the inquiry delivered its findings, and which continues to delay reform and affect access to healthcare.
The committee met on Wednesday and was briefed by the Council for Medical Schemes (CMS) on the Section 59 report and the HMI report. However, the committee noted that the presentation offered more in hopes and intentions than concrete, measurable actions. This prompted several committee members to question the regulator’s commitment to protecting healthcare professionals and the public interest.
Briefing the committee, the CMS explained that the Section 59 investigation was initiated in response to significant concerns raised by healthcare providers, including the National Health Care Professionals Association (NHCPA) and the Solutionist Thinkers. The investigation highlighted several key issues, such as challenges in process fairness and consistency, questions regarding audit practices and recoupment approaches, and broader perceptions of imbalance within the system. CMS indicated that the report is viewed as a regulatory response to systemic issues rather than isolated incidents.
The HMI examined various structural features of the private healthcare market, focusing on competition dynamics, pricing structures, and benefit design and transparency. Its findings indicate that many challenges within the system are structural in nature and require coordinated, system-wide interventions.
The CMS said it has adopted a phased and structured approach to implementing both Section 59 and the HMI recommendations. This is to ensure legal certainty and takes into consideration the need for stakeholder alignment and the risks associated with acting outside the law.
During the engagement, one of the recurring questions raised by committee members was the lack of concrete action on the part of CMS, seven years after the inquiry. They also asked how healthcare professionals who have suffered losses will be compensated and demanded a clear timeline for when the recommendations will be enacted. They also raised questions about lack of accountability, and consequence management in terms of who would be held responsible for the slow pace of reforms.
Discussions amongst committee members included concerns about legislative bottlenecks, particularly regarding specific provisions in the Medical Schemes Act that block risk equalisation mechanisms and basic benefit packages. Members inquired about the timeline for presenting amendment legislation to Parliament, highlighting the urgency of these issues.
Additionally, questions arose about the CMS’s enforcement of stricter cost-control measures, particularly in the context of HMI recommendations. The committee stressed the need for transparency and accessible information regarding medical aid options and costs, to enable the public to make informed decisions.
The CMS acknowledged the delay in implementation and committed to providing a detailed timeline for the execution of recommendations. However, CMS also emphasised that many of the necessary regulatory changes depend on cooperation with the Department of Health.
On accountability, the CMS assured the committee that it is working to establish measures for non-performance and will provide a dashboard tracking the progress of recommendations, indicating which have been fully implemented, partially implemented, or not started, along with deadlines.
The CMS also discussed efforts to address legislative bottlenecks and the necessary amendments to the Medical Schemes Act, in collaboration with the Department of Health.
In response to the committee’s cost control concerns, the CMS said it has developed a universal code of conduct designed to ensure fair pricing and transparency across the industry. This aims to address issues identified in the Section 59 investigation.
Moreover, the CMS confirmed it has engaged with various stakeholders and is committed to incorporating their feedback into the reform process. This collaborative approach is deemed essential for aligning interests and achieving meaningful change.
Regarding the waiting periods imposed on medical aids, the CMS acknowledged the concerns raised and stated it are reviewing this policy to ensure fair treatment for members who have maintained continuous coverage.
The committee also noted the importance of address the issue of medical aid rates, which was also raised in the HMI report. Some committee members provided insight into current discussions in the context of past decisions. For example, they noted that there used to be a gazette that guided funders and patients on appropriate rates. However, this was discontinued due to actions taken by the Ministry of Trade and Industry and the Competition Commission. The current recommendations are the same as ones halted in the early 2000s.
Committee members also noted that the HMI is an initiative of the Department of Trade and Industry. They therefore resolved that in the second parliamentary term a joint meeting will be held with Trade and Industry. In addition, the committee will ask CMS to provide a list of the necessary amendments to the law to be properly prepared for the engagements.
On the issue relating to the Section 59 report, the committee said it is difficult to accept that in a post-democratic South Africa, Black lives don’t matter especially as this issue particularly affects Black healthcare professionals, as stated in the report. The committee noted the finding that the Section 59 investigation exposed racially biased algorithmic systems that disproportionately targeted Black healthcare practitioners. The committee demanded to know what immediate corrective and compensatory action will be taken.
The committee suggested the need for an ombud for medical aid issues, which would serve as an independent body for all aggrieved parties, whether they are practitioners, members or funders. Recovery claims would be adjudicated independently to ensure due process. Committee members were of the view that a Section 59 investigation should operate like an SIU operation, with clear rules about where clawback money goes.
Regarding evergreen contracts between medical schemes and dominant hospital groups, the committee questioned why there is no decisive regulatory intervention to review these contracts. The committee said the CMS has jurisdiction over these issues but is failing to act. This inaction raises concerns about the state’s readiness to implement the National Health Insurance.
The committee called on the regulator to provide clear timelines for implementing all Section 59 and HMI recommendations, a legislative roadmap and an immediate review of all evergreen contracts. In addition, fraud cases must be pursued by law enforcement.
The committee also tabled detailed questions for CMS, which it must answer within seven days. A follow-up meeting with CMS is also planned for further engage on the issues and concerns expressed by the committee and will include affected stakeholders.
ISSUED BY THE PARLIAMENTARY COMMUNICATION SERVICES ON BEHALF OF THE CHAIRPERSON OF THE PORTFOLIO COMMITTEE ON HEALTH, MS FAITH MUTHAMBI.
For media inquiries or interviews with the Chairperson, please contact the committee’s Media Officer:
Name: Yoliswa Landu (Ms)
Cell: 081 497 4694
E-mail: ylandu@parliament.gov.za
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