Business and the government are working to try and finalise a funding mechanism that will enable some adults who don’t have medical aid to receive their free vaccinations in private sector pharmacies, doctor’s rooms, workplaces or mass vaccine sites, reported Business Times (23 May 2021). The mechanism would provide for private providers to be paid by the state to vaccinate a set number of non-medical aid patients, just as they will get paid by the medical aids to vaccinate their members.

In most countries, the state is paying to vaccinate everyone wherever they receive their doses, but SA has opted for a mix of private and public funding, with facilities charging medical aids for their members at rates set by the government. This requires a complicated two-stream payment system, according to Discovery Health’s Ron Whelan. The costing of the vaccines to medical aids, is R345.75 (including VAT) per dose for Pfizer - two doses will be needed - and R330 (including VAT for) each Johnson & Johnson dose. In addition, an R80.50 administration fee (including VAT) will be charged to cover the cost of vaccinators and of consumables such as syringes.

Pharmacies and doctors have established mechanisms to charge medical-scheme administrators, but the question is how to bill the Treasury, and how many people the state will be willing, or able, to fund to be vaccinated at private facilities.

Whelan estimates the medical schemes, which will mainly be in for the more costly two-dose Pfizer vaccines, are in for a total of R3.5-bn to R4-bn to vaccinate their 7.1-m adult members.

 

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