The medical aid sector hasn't made it easier for low-income earners to come on board. Plans to probe pricing gained momentum, then faded.

However, what came as a surprise was Patrick Masobe's court defeat at the hands of Genesis this time last year. More recently, Masobe, the head of the Council for Medical Schemes (CMS), suffered his second court defeat - this time at the hands of Alexander Forbes-held Guardrisk over its controversial "gap cover".

The CMS is now considering going to parliament to have those insurance products that discriminate on the basis of age and health profile outlawed.

But legislative intervention will take a while. Look at the example of the Medical Schemes Amendment Bill gathering dust while some trustees do as they please.

The draft bill paves the way for the establishment of the long-awaited Risk Equalisation Fund, and is aimed at curbing perverse incentives between schemes and service providers such as administrators.

"There is a trend towards medical schemes' boards becoming increasingly autonomous," says Medscheme CE André Meyer. Like Discovery Holdings boss Adrian Gore, Meyer denies that funds and admin firms are "joined at the hip".

Apart from this, it's going to be another busy year for the CMS and its lawyers. In 2006, the regulator spent R4,9m of taxpayers' money in legal fees.

Gore and Meyer may be sitting with bruises after a rough year, but they have their eyes on the Government Employees Medical Scheme tender. Meanwhile, Old Mutual SA, which is set to merge with Medscheme, as well as AllCare, Sanlam and Sechaba administrators, are all too small to play in this space.

Back to the losers. Gore quit the US after losing R1bn of investors' funds on the Destiny operation. At home, he's happy that his firm, now managing 2,1m lives, "continues to grow at over 1 000 members per day". At this rate, the firm should easily hit 3m by 2010.

Medically insured people - now totaling 7,5m - are the biggest losers. Once again, they have had to dig deeper to contend with runaway nonhealth-care costs (such as admin and broker fees); inflated medical prices; and industry fraud. Conversely, some administrators and overservicing providers are making bundles of cash.

Haroon Wadee of the Board of Healthcare Funders, the industry's umbrella body, concedes that "economies of scale" should lower admin fees, but that's unlikely to find resonance with his members. Poor people, who have been awaiting the arrival of the low-income medical scheme (Lims) for the past three years, can expect to wait a little longer.

Schemes with questionable principal officers or boards and poor financial positions haven't escaped Masobe's attention. This augurs well for the medically insured - if he can keep cracking the whip, which could, in turn, help lower fees.