Day: October 2, 2023

Categories : Expert Opinion Healthcare Politics and RegulationsTags :

National Health Insurance Bill: Will it Wipe out Medical Insurance?

On By ModernMedia

The NHI Bill does not contain any clarity on how South Africa’s large and complex medical schemes and insurance industry will be affected.

Photo by Bill Oxford on Unsplash

By Lenee Green, Partner, Mateen Memon, Associate & Mariam Ismail, Trainee Attorney at Webber Wentzel

On 12 June 2023, the National Health Insurance Bill (the Bill) was passed by the National Assembly and is currently with the National Council of Provinces for consideration. Its laudable aim is to make primary healthcare widely accessible.

The Bill has been closely scrutinised by various stakeholders in the healthcare sector. Concerns have been raised by medical schemes and insurers about the effect the Bill will have on their current businesses.

The Bill, among other things, covers:

  • who will be able to access health care services;
  • how these services will be funded;
  • the establishment of a board and advisory committees to achieve the objectives of the Bill;
  • general provisions applicable to how the fund will operate;
  • complaints about and appeals of decisions made by the fund; and
  • the source of income of the Fund and transitional arrangements.

Clause 33 of the Bill states that once the National Health Insurance (NHI) is fully implemented, medical schemes can only offer complementary coverage for services not reimbursed by the NHI. Clause 6(o) of the Bill allows individuals to purchase services not covered by the NHI through voluntary medical insurance schemes. This means medical schemes cannot cover services already covered by the NHI, potentially jeopardising their existence. This approach may face constitutional challenges related to the right to access healthcare, property rights of medical schemes, and freedom of trade and profession.

It is contemplated that the Minister of Health will introduce regulations limiting benefits to services not reimbursable by the Fund.  We have not yet seen any indication when these regulations will be published.

Current regime

Broadly, four main categories of business will be impacted by the Bill:

  • business of a medical scheme as defined in the Medical Schemes Act 131 of 1998 (MSA);
  • insurers licensed to conduct insurance business pursuant to the Insurance Act 18 of 2017 (the Insurance Act);
  • insurers who offer products pursuant to section 8(h) of the MSA (the Exemption Framework); and
  • insurers who offer products pursuant to the regulations published under each of the Long-Term Insurance Act 52 of 1998 and the Short-Term Insurance Act 53 of 1998 (the Demarcation Regulations).

Medical schemes

Presently, only medical schemes may carry on the “business of a medical scheme” as defined in the MSA. The “business of a medical scheme” involves undertaking liability for the provision of obtaining “relevant health services”, defraying expenditure for “relevant health services” or rendering health services by the medical scheme itself or by any supplier of a “relevant health service” in return for a premium or contribution.

A “relevant health service” under the MSA is very wide. It includes “any health care treatment of any person by any person registered in terms of any law, which treatment has as its object…” The objects include a broad range of medical services, including the physical or mental examination of a person, the diagnosis, treatment or prevention of any physical or mental defect, illness, or deficiency, ambulance services and hospital or similar accommodation.

Insurers

Medical schemes must be distinguished from medical insurance provided by insurers. Insurers may provide medical insurance under, among other dispensations, the Insurance Act. Schedule 2 to the Insurance Act provides for various classes and sub-classes of insurance business for which life insurance companies and non-life insurance companies may be licensed. Schedule 2 allows insurers to provide health and disability benefits under the risk class of business for life insurance and accident and health and travel insurance under the classes for non-life insurance.

Health insurance is provided upon the happening of a health event. A health event is defined in the Insurance Act as one that relates to the health, mind or body of a person or an unborn, other than a disability event. The disability event is defined and includes circumstances where a person loses a limb or becomes physically or mentally impaired. It is apparent that there is an overlap of products provided for in the Insurance Act and offered under the MSA.

The Demarcation Regulations provide for the demarcation between insurance business and medical schemes business. The regulations provide that a benefit that would otherwise have been a medical scheme benefit, but meets the exact requirements (definitions) set out in the tables in the Demarcation Regulations, is classified as an insurance product.

In March 2017, the Counsel for Medical Schemes (CMS) issued an exemption framework for insurers as a transitional arrangement while the development of a low-cost benefit option (LCBO) for medical schemes was developed (Exemption Framework). To the extent that an exemption was granted to an insurer in terms of section 8(h) of the MSA, and subject to the conditions of the exemption, the insurer was permitted to continue to underwrite those products until the expiry of the exemption. On 25 January 2022, the CMS granted insurers that had previously been granted an exemption in terms of the Exemption Framework an extension of a further two years.

The background to the LCBO is that a ministerial task team on social health insurance launched the low-income medical scheme consultative process in 2005. In 2015, the CMS issued a circular that considered introducing a guideline to allow medical schemes to introduce LCBOs in response to the growing number of working South Africans who did not have medical scheme coverage because they could not afford it. Following various engagement processes, the LCBO Framework Advisory Committee issued a Report in May 2022 (the Report). The Report states that LCBOs still have the potential to “alleviate pressure in the public healthcare system and allow resources to be redirected to the poor”. This process has progressed quite slowly, and it remains to be seen what comes of it if anything.

While the Bill is a piece of framework legislation, it does not provide clarity on what will become of insurance under the current regime. The fate of medical schemes is dealt with in a very cursory manner, without considering the nuances of the current regime.

The LCBO could have been a path to make healthcare more accessible, but the process has become stifled, and it may never come to fruition. What is left in the wake of the Bill is a great deal of uncertainty. Industry participants and stakeholders will have to keep abreast of the process and ensure that their comments are taken into account as the system evolves.

Categories : Allergies Immune SystemTags :

Does the ‘Hygiene Hypothesis’ Still Hold Water?

On By ModernMedia
Photo by Andrea Piacquadio on Unsplash

Over the last few decades, there has been growing popularity for the ‘hygiene hypothesis’, which suggests that some level of microbial exposure helps protects against developing allergy. Now, an article published in Science Immunology by researchers from Karolinska Institutet challenges this hypothesis by showing that mice with high infectious exposures from birth have the same, if not an even greater ability to develop allergic immune responses than ‘clean’ laboratory mice.

Studies have suggested that certain infections might reduce the production of inflammatory antibodies to allergens and alter the behaviour of T cells involved in allergies. It has also been suggested that ‘good’ intestinal bacteria could shut off inflammation elsewhere in the body.

Robust allergic responses

Researchers have now compared the allergic immune response in ‘dirty’ wildling mice to those of typical clean laboratory mice. They found very little evidence that the antibody response was altered or that the function of T cells changed in a meaningful way. Nor did anti-inflammatory responses evoked by good gut bacteria appear to be capable of switching off the allergic immune response. On the contrary, wildling mice developed robust signs of pathological inflammation and allergic responses when exposed to allergens.

“This was a little unexpected but suggests that it’s not as simple as saying, ‘dirty lifestyles will stop allergies while clean lifestyles may set them off’. There are probably very specific contexts where this is true, but it is perhaps not a general rule,” says Jonathan Coquet, co-author of the study and Associate Professor at Karolinska Institutet.

More like the human immune system

The wildling mice are genetically identical to clean laboratory mice but are housed under ‘semi-natural’ conditions and have rich microbial exposures from birth.

“The immune systems of wildling mice better represent the human immune system and so we hope that they can bring us closer to the truth of how microbes act upon the body,” says Jonathan Coquet.

The findings contribute to the general understanding of how allergies may arise and may also have clinical implications. Using experimental infections to treat patients suffering from inflammatory diseases has also been attempted in recent clinical trials. For example, infecting people with worms or performing faecal transplantations has been proposed as a tool to combat inflammatory diseases. Newborns delivered through C-section, have had maternal faecal transplantation and bacterial supplementation with the aim of promoting good bacteria in the baby’s gut and the child’s future health.

Beneficial effects of exposure not clear as we’d like

“This field of research can provide important insights into how infections and microbes can be used to facilitate health, but it is still in its infancy. Our study is a reminder that general and broad exposures to microbes may not have the clear beneficial effects that we wish them to have,” says Susanne Nylén, co-author of the study and Associate Professor at the Department of Microbiology, Tumor and Cell Biology at Karolinska Institutet.

Source:

Categories : Cardiovascular Disease ExerciseTags :

50 Steps a Day Cuts Heart Disease Risk by 20%

On By ModernMedia
Credit: Pixabay CC0

Forget walking 10 000 steps a day – climbing up at least 50 steps a day could significantly reduce the risk of heart disease, according to a new study from Tulane University.

The study, published in Atherosclerosis, found that climbing more than five flights of stairs daily could reduce risk of cardiovascular disease by 20%.

Atherosclerotic cardiovascular disease (ASCVD) along with coronary artery disease and stroke are the leading causes of morbidity and mortality worldwide.

“Short bursts of high-intensity stair climbing are a time-efficient way to improve cardiorespiratory fitness and lipid profile, especially among those unable to achieve the current physical activity recommendations,” said co-corresponding author Dr Lu Qi, professor at Tulane University. “These findings highlight the potential advantages of stair climbing as a primary preventive measure for ASCVD in the general population.”

Using UK Biobank data collected from 450 000 adults, the study calculated participants’ susceptibility to cardiovascular disease based on family history, established risk factors and genetic risk factors and surveyed participants about their lifestyle habits and frequency of stair climbing. Median follow-up time was 12.5 years.

The study found that climbing more stairs daily especially reduced risk of cardiovascular disease in those who were less susceptible. However, Qi said the increased risk of heart disease in more susceptible people could be “effectively offset” by daily stair climbing.

Qi touted the public availability of stairs as a low-cost, accessible way to incorporate exercise into daily routines.

“This study provides novel evidence for the protective effects of stair climbing on the risk of ASCVD, particularly for individuals with multiple ASCVD risk factors,” Qi said.

Source: Tulane University

Categories : Cardiovascular Disease New Compounds and TreatmentsTags :

Fast-acting Nasal Spray Could Treat Tachycardia Episodes

On By ModernMedia
Photo by Stephen Andrews

A fast-acting drug delivered as a nasal spray may someday allow patients with intermittent tachycardia to treat it themselves as soon as they develop symptoms, according to new research published in the Journal of the American Heart Association. The drug is still under development and awaiting approval in the US by the Food and Drug Administration.

“This is a potential new and exciting option for patients to safely self-treat their rapid heartbeat without direct medical supervision to avoid emergency room visits and medical interventions,” said lead author James E. Ip, MD, an associate professor of clinical medicine at Weill Cornell Medicine at New York-Presbyterian Hospital.

About 1 in 300 people in the United States experience intermittent periods paroxysmal supraventricular tachycardia, a condition characterised by rapid heartbeat (>100bpm, and more typically 150–200 bpm) in the lower chambers of the heart.

The standard treatment during an episode is to perform vagal manoeuvres, one of which is done by trying to bear down, achieved by breathing out with stomach muscles but not letting air out the nose or mouth. This can make the vagus nerve slow electrical conduction through the atrioventricular (AV) node, which regulates the timing of the electrical pulses to the lower portion of the heart. If the self-administered vagal manoeuvres are not effective (which happens about 20–40% of the time), the person should seek immediate treatment of intravenous medication at an emergency room to return the heart rate to normal. In the United States, about 50,000 emergency room visits a year are for paroxysmal supraventricular tachycardia, Ip said.

In a previous study, people with the disorder treated themselves with either etripamil or a placebo nasal spray for a single episode of rapid heartbeat. Participants applied an electrocardiogram (ECG) patch at the onset of symptoms, did a vagal manoeuvre and self-administered the nasal spray if the rapid heartbeat continued – keeping the ECG patch on for at least five hours. In that study, the first time that etripamil was used without direct supervision, normal heart rhythms were restored within 30 minutes in 54% of patients, compared to 35% with placebo, and the medication was found to be safe and well tolerated. The ECG patch is a wearable heart monitor that has a small device with an adhesive that sticks on the chest skin surface and is wirelessly connected to a cell phone to transmit the ECG data.

All people in that randomised trial were invited to participate in the current open-label study that allowed patients to self-treat with etripamil during multiple episodes of paroxysmal supraventricular tachycardia (PSVT). Of the 169 patients enrolled, 105 self-administered at least one dose of etripamil (70mg) during the median 232-day study period.

The new study found:

  • Etripamil restored heart rate to normal within 30 minutes in 60.2% of the 188 verified PSVT episodes, and within an hour in 75.1% of the episodes.
  • Of the 40 participants who self-treated two episodes, 63.2% responded to the medication within 30 minutes. Nine people (23%) did not convert to a normal heart rate on either episode, and 21 (53%) converted to normal heart rate on both episodes.
  • Safety was assessed regardless of whether the episode was confirmed by ECG. Thirty-four participants (32.4%) reported one or more side effects from the medication, most commonly mild-to-moderate nasal congestion or discomfort, or a runny nose. There were no serious heart-related adverse events.

“There are no great options for patients to self-treat paroxysmal supraventricular tachycardia, and this condition can cause significant distress and anxiety,” Ip said. “Similar to an albuterol inhaler for asthma patients or an epinephrine pen for patients that have severe allergies or anaphylaxis, etripamil nasal spray may be a great option for people who have paroxysmal supraventricular tachycardia.

Source: American Heart Association

Categories : Expert Opinion Medical IndustryTags :

Opinion Piece: Commemorating Carers Week: Putting the Spotlight on South Africa’s Unsung Heroes

On By ModernMedia

By Donald McMillan, Managing Director at Allmed Healthcare Professionals

Donald McMillan

The caregiving workforce plays a crucial role in our society, but their efforts often go unnoticed. These individuals, known as carers, selflessly care for those in need due to factors such as illness, age, or frailty. Unfortunately, they face numerous challenges that can take a toll on their well-being. It’s important to raise awareness of their struggles and provide them with the necessary support. To bring these issues to the fore, communities are coming together between the 2nd – 6th of October 2023 to commemorate Carers Week.

Caregivers have an enormous responsibility that often goes unnoticed by society. The emotional strain that comes with caregiving can have a direct impact on their mental health and often leads to depression. They often devote their time and interests to the role of voluntary caregivers and face many challenges due to the lack of recognition and support from their professional peers and society in general.

Initiatives in place

In response to these issues, governmental efforts have been put forth to assist both caregivers and non-governmental organisations with the aim of alleviating some of the financial burdens associated with their work. A noteworthy instance of this support is exemplified in the community home-based care program run by The Association for the Aged (TAFTA), which secures government funding to informal caregivers. This initiative and others like it, combined with the Carer’s Grant are part of positive strides being made within this space. However, further support is still needed to ensure that caregivers receive adequate support as they strive to provide high-quality care to their patients.

The government alone cannot be the only one providing support to carers as society and the private sector each have to role to play in alleviating the burden that sits on the shoulders of carers, particularly within impoverished and rural communities. The logical progression is for the government and all stakeholders to channel their resources into a comprehensive framework that encompasses financial aid, training, and support services for carers. Additionally, the pursuit of affordable and inventive caregiving solutions cannot be neglected.

Rising to meet growing demands

As South Africa’s population ages and chronic illnesses surge, the demand for caregiving services has swelled to unprecedented levels. To adequately address these escalating requirements, several measures must be adopted. Establishing community-based networks of support can furnish practical assistance and emotional solace. Carers must also receive enhanced training and upskilling to hone their capabilities, all the while being granted the acknowledgement and admiration they rightfully deserve.

It is imperative for entities that offer caregiving employment to invest in training to equip carers with the tools required for high-quality care provision. The integration of emotional counselling facilitated by clinical experts constitutes another crucial component of the caregivers’ support structure.

Strengthening the system

The symbiotic relationship between government bodies, stakeholders, and relevant associations is pivotal in reshaping the caregiving landscape. The collaboration between the Department of Social Development (DSD) and the South African Association of Homes for the aged- (SAAHA), exemplified by their joint registration of care workers both formal and informal, signifies a significant step toward accountability and much-needed assistance. The synergy of corporate involvement and government funding has the potential to revolutionise the lives of caregivers in both formal and informal capacities.

Upskilling the informal carer workforce stands as a cornerstone for improving the quality of caregiving. Creating and running specialised courses tailored for caregivers is essential, as it not only enriches their knowledge and competencies but also bolsters their confidence, employability, and job satisfaction. These comprehensive courses should span various aspects, from personal care to dementia management, empowering caregivers to confront their daily challenges head-on.

Galvanising society

As mentioned, support for carers should transcend the boundaries of governmental programs and corporate ventures. The broader society has a pivotal role in elevating the status of carers. Displaying empathy, extending practical aid, advocating for improved resources, and propagating awareness about the struggles of caregivers all fall within our capability as members of the public. Initiatives rooted in communities, campaigns, and programs can collectively reshape perceptions and extend tangible support.

Carers are one of the important pillars on which our society relies, and more need for recognition of their contributions and tribulations must be given. By advocating for increased support, enhanced financial backing, and inventive solutions, we can uplift carers and ensure their endeavours do not remain obscured. With the collective resolve of government bodies, stakeholders, businesses, and the populace, we can pave the path to a brighter, more nurturing future for carers and their cherished ones.

Categories : Mental HealthTags :

Mental Health is Critical when Facing a Dread Disease Diagnosis, Treatment, or Bereavement

On By ModernMedia
Photo by Alex Green on Pexels

A diagnosis of cancer or another dread disease is a devastating blow, not only for the patient but for their family and loved ones. The diagnosis itself, the trauma of going through treatments and the bereavement of losing someone all take their toll on mental wellbeing. Depression, anxiety, and mental illness frequently go hand in hand with physical illnesses like cancer. It is an isolating experience, and often people struggle through these feelings alone, but this does not have to be the case.

There is help available with programmes designed to support families on the cancer journey. There is also financial support available from elements such as gap cover, where value-added benefits may cover items like trauma counselling, which can be a lifeline in times of great need. Looking after your mental health is essential, both for fighting disease and coping with the trauma of diagnosis and subsequent loss.

Evy Michalopoulos is the Founder and CEO of Machi Filotimo Cancer Project, a non-profit organisation that raises awareness about cancer, its symptoms and treatment, and helps to guide cancer patients and their families as they navigate this difficult journey. She believes that sound mental health is absolutely critical, both for patients fighting cancer and for families who are on this journey with a loved one or have already experienced a loss.

“Especially when a diagnosis or a loss is sudden and unexpected, feelings of anger, grief, frustration and guilt are common, and all of these emotions come into play at various stages, often in waves. We often feel the need to be strong, which typically involves locking our feelings away, but this frequently leads to mental health issues like depression and anxiety, and feelings of being overwhelmed,” Michalopoulos says.

“There is also a persisting perception that seeking help means you are weak, but nothing could be further from the truth. Mental strength is essential in fighting diseases like cancer, and developing this strength requires support. Professional help can be hugely valuable in helping you to process grief and give you the tools you need to deal with challenges in a constructive way, whether you have lost a loved one, are going through treatment, or have someone close to you who has received a diagnosis,” she adds. 

In situations like this, it helps to know that you are not alone. Organisations like Machi Filotimo are there to help patients and their families and loved ones, providing a vital support system. Alongside this support, it is also recommended that people in situations like a cancer diagnosis also seek professional mental healthcare treatment. However, often the cost of this can put people off, especially when they are already facing potential medical expense shortfalls relating to cancer treatments.

“This is where gap cover is essential. Not only does gap cover give you peace of mind that many of these shortfalls will be covered, but certain providers also have value-added benefits. For example, Turnberry offers Trauma Care Cover, which covers the cost of trauma counselling consultations with a registered healthcare provider after a critical illness diagnosis or the death of an immediate family member,” explains Tony Singleton, CEO at Turnberry.

Knowing that care is available and that finances will not be a hurdle in receiving the treatment you or a loved one needs, whether for physical or mental health, can significantly reduce the massive stress that critical illness and dread disease create. This then gives more freedom to focus on fighting the disease itself, rather than worrying about paying for treatments.

“The best advice I can give people is to make sure they have the options available to explore, to make better choices that can lead to better outcomes. Having gap cover in place facilitates many more choices, but people need to be open to asking for and receiving help, especially when it comes to mental well-being. Asking for help is not a sign of weakness, and there is help available. Reach out, get as much information as you can, and take advantage of what is there and available. You do not have to walk this journey alone,” Michalopoulos concludes.

About Turnberry Management Risk Solutions

Founded in 2001, Turnberry is a registered financial services provider (FSP no. 36571) that specialises in Accident and Health Insurance, Travel Insurance, and Funeral Cover. With extensive experience across healthcare and insurance industries in South Africa, Turnberry offers unsurpassed service to Brokers and clients. Turnberry’s gap cover products are available to clients on all medical aid schemes, as they are independently provided and are therefore transferable in the event of a change in the client’s medical aid scheme. Turnberry is well represented nationally, with its Head Office based in Bedfordview, Johannesburg with Business Development Managers in Cape Town and Durban. The Turnberry Team’s focus on outstanding client service comes from having extensive knowledge and experience in the financial services sector and is underwritten by Lombard Insurance Company Limited. Lombard Insurance Company Limited is an Authorised Financial Services Provider (FSP 1596) and Insurer conducting non-life insurance business.