Tag: 24/1/24

Categories : Healthcare Politics and Regulations Medical IndustryTags :

Does NHI Spell the End for Medical Aid and Gap Cover?

On By ModernMedia
Photo by National Cancer Institute on Unsplash

South Africa’s National Health Insurance (NHI) Bill would, if passed in its current form, completely disrupt the medical sector in the country and would inevitably reshape the role of medical schemes as well as gap cover.

However, the implementation of NHI does not necessarily mean that medical aid and gap cover will no longer have a role to play, because there are many possible scenarios in which they will continue to be an important part of the landscape. It is important to understand your current coverage from both a medical aid and gap cover perspective so that when the NHI does come into effect, you can make an informed decision that will be best for your needs.

A long road ahead

Given the potential for the current NHI Bill to face legal challenges, we are driven by a shared responsibility to safeguard the health and well-being of all citizens. The risk of lengthy court battles cannot be underestimated, as they may inadvertently prolong the uncertainty and affect the timely implementation of essential healthcare reforms. According to Andre Jacobs, Marketing Manager at The People Company and Vice Chair of the FIA Health Exco, these challenges include constitutional, funding, affordability, policy and supply-side demand issues.

“There are also conflicting points of information within the current Bill that need to be resolved. For example, in Section 33, the Bill states that once NHI is implemented, medical schemes can play a top up role, which could mean different things. It could imply that they may only provide cover for anything that is not primary care, or that they may only provide specialised dentistry cover or advanced oncology treatment,” says Jacobs. 

“However, if one reads the definition of a health service and a health product with section 2(a) of the NHI Bill, it states that all health services will be provided by the NHI Fund and that they are the single purchaser and provider of health services. Therefore, whilst section 33 provides a role for medical schemes, it would be impossible to operate,” he adds.

A matter of speculation

The reality is that it is yet to be determined what benefits the NHI Fund will provide. This means that the role of medical schemes, and therefore the role of gap cover, is a matter of speculation at present. The structure of the current medical scheme and gap cover range may need to be adjusted to align with the NHI offering that is enacted.

This may lead to the design of products moving toward a defined benefit structure where a particular medical intervention, such as a broken leg, has a defined benefit that is paid out irrespective of the amount of cover provided by the NHI. This amount could then be utilised to pay for a private procedure. It is also likely that high-cost treatments such as specialised dentistry or advanced cancer treatment or biological medicine will not be provided by the NHI Fund. However, the regulations post-NHI will dictate what can be offered.

“If we use overseas experience by way of example, there will be a role for both National Health and private insurance products, where the private cover will provide additional benefits to complement the base offering of the NHI. For example, we often see this as providing a fast track for certain elective procedures that a person may need to address due to personal circumstances,” says Tony Singleton, CEO of Turnberry Management Risk Solutions. 

Make sure you are covered in any eventuality

“The goal of expanding universal healthcare should be supported, but rather than abolishing private healthcare, South Africa should leverage the private sector to expand the level of universal health cover. We can develop a dualistic healthcare system with the same universal coverage elements based on social solidarity principles, with a healthcare system that is accountable to the communities it serves. Transitioning to a more equitable healthcare system demands not only sound policy decisions, but also a shared commitment to overcoming societal attitudes and cultural beliefs that might hinder progress,” says Jacobs.

Private medical schemes are an asset that should be leveraged to drive healthcare innovation and foster advancements for the broader healthcare sector, and the healthcare system needs to provide meaningful choices through an accessible, inclusive, and adaptable system that caters to the diverse needs and preferences of the population.

Gap products currently play an important role in protecting your financial wellbeing in the event that medical expenses exceed what medical schemes will reimburse. In the current landscape, where the future state of the NHI is uncertain, there is still a definite need for both medical aid and gap cover to ensure access to quality private healthcare. In addition, gap cover for the use of non-Designated Service Providers (DSPs) will continue to be important even after a National Health product comes into effect.

“Before making any decisions, it is important to understand the cover provided by your medical aid and to understand any limitations that your plan may have. To assist you with this, it is useful to have your financial advisor review your medical aid coverage. They will be able to identify the type of gap product that will be most complementary to your Medical Aid plan whilst at the same time understanding your family’s unique health and financial situation,” Singleton 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.

Categories : HIVTags :

Starting HIV Treatment Early may be Key to Remission

On By ModernMedia
Colourised scanning electron micrograph of HIV (yellow) infecting a human T9 cell (blue). Credit: NIH

Some people with HIV, known as “post-treatment controllers,” have been able to discontinue their antiretroviral treatment while maintaining an undetectable viral load for several years. Starting treatment early could promote long-term control of the virus if treatment is discontinued.

Scientists from the Institut Pasteur and other institutes used an animal model to identify a window of opportunity for the introduction of treatment that promotes remission of HIV infection. The findings, published in Nature Communications, suggest that starting treatment four weeks after infection promotes long-term control of the virus following the interruption of treatment after two years of antiretroviral therapy.

These results highlight how important it is for people with HIV to be diagnosed and begin treatment as early as possible.

Research on the VISCONTI cohort, composed of 30 post-treatment controllers, has provided proof of concept of possible long-term remission for people living with HIV. These individuals received early treatment that was maintained for several years.

When they subsequently interrupted their antiretroviral treatment, they were capable of controlling viraemia for a period lasting more than 20 years in some cases. At the time (in 2013), the team leading the VISCONTI study suggested that starting treatment early could promote control of the virus, but this remained to be proven.

In this new study, the scientists used a primate model of SIV1 infection which allowed them to control all the parameters (sex, age, genetics, viral strain, etc.) that may have an impact on the development of immune responses and progression to disease.

They compared groups that had received two years of treatment, starting either shortly after infection (in the acute phase) or several months after infection (in the chronic phase), or no treatment.

The reproducible results show that starting treatment within four weeks of infection (as was the case for most of the participants in the VISCONTI study) strongly promotes viral control after discontinuation of treatment.

This protective effect is lost if treatment is started just five months later.

“We show the link between early treatment and control of infection after treatment interruption, and our study indicates that there is a window of opportunity to promote remission of HIV infection,” comments Asier Sáez-Cirión, Head of the Institut Pasteur’s Viral Reservoirs and Immune Control Unit and co-last author of the study.

The scientists also demonstrated that early treatment promotes the development of an effective immune response against the virus.

Although the antiviral CD8+ T immune cells developed in the first weeks after infection have very limited antiviral potential, the early introduction of long-term treatment promotes the development of memory CD8+ T cells, which have a stronger antiviral potential and are therefore capable of effectively controlling the viral rebound that occurs after treatment interruption.

“We observed that early treatment maintained for two years optimises the development of immune cells. They acquire an effective memory against the virus and can eliminate it naturally when viral rebound occurs after discontinuation of treatment,” explains Asier Sáez-Cirión.

These results confirm how important it is for people with HIV to be diagnosed and begin treatment as early as possible.

“Starting treatment six months after infection, a delay that our study shows results in a loss of effectiveness, is already considered as a very short time frame compared with current clinical practice, with many people with HIV starting treatment years after infection because they are diagnosed too late,” notes Roger Le Grand, Director of IDMIT (Infectious Disease Models for Innovative Therapies) and co-last author of the study.

“Early treatment has a twofold effect: individually, as early treatment prevents diversification of the virus in the body and preserves and optimises immune responses against the virus; and collectively, as it prevents the possibility of the virus spreading to other people,” adds Asier Sáez-Cirión.

Finally, these results should guide the development of novel immunotherapies targeting the immune cells involved in the remission of HIV infection.

These are the initial results of the p-VISCONTI study, which began in 2015 in collaboration with the institutions cited above and received funding from MSD Avenir and the support of ANRS Emerging Infectious Diseases as part of the RHIVIERA consortium.

1 SIV: simian immunodeficiency virus only affects non-human primates. SIV infection of animals recapitulates the key features of human HIV infection.

Source: Institut Pasteur

Categories : Diet and NutritionTags :

People with Gluten Sensitivity have Negative Effects – Even When Eating a Placebo

On By ModernMedia
Photo by Mariana Kurnyk

Symptoms of gluten sensitivity are partly to do with people’s expectations, if celiac disease and wheat allergy have been excluded as causes. Recent research at the universities of Maastricht and Leeds shows that the expectation that gluten causes gastrointestinal complaints plays a crucial role in whether or not people experience these symptoms. These results, published in The Lancet Gastroenterology and Hepatology, indicate a direct involvement of the interaction between the brain and the intestines – the ‘gut-brain axis’ – in the experience of complaints after ingesting gluten.

Fear of gluten

A growing number of people are reducing their gluten intake due to self-reported digestive complaints, despite the fact that celiac disease and wheat allergy have been ruled out. The cause of their symptoms is often unclear. The researchers therefore wanted to investigate the effects of expectations on symptoms experienced after gluten intake. More than 80 subjects with self-reported gluten sensitivity took part in a psychological study and were divided into four groups. The results were unequivocal: people who thought they were eating food containing gluten reported more symptoms, while those who thought their food was gluten-free reported fewer symptoms.

In reality, the food given to half of each group contained gluten, while for the other half it was gluten-free. In all of the groups people’s expectations played a prominent role in whether or not they reported symptoms after eating. “In our research, we see a so-called nocebo effect when people eat gluten,” says researcher Marlijne de Graaf. “If people expect gluten to produce negative effects, they experience symptoms, even if it turns out afterwards that they weren’t actually eating gluten. Although the cause is partly ‘in the mind’, this doesn’t mean that the symptoms are not real.”

Gut-brain axis

The results of this study indicate a clear involvement of the interaction between the brain and the intestines in gluten sensitivity, a subject on which knowledge is as yet limited. The researchers therefore now want to concentrate on unravelling the mechanisms that determine the importance of expectation and exposure along the gut-brain axis. ‘Due to the influence of interactions between the brain and the intestines, people can genuinely experience symptoms such as stomach ache, bloating or diarrhoea after eating gluten,’ says Daisy Jonkers, professor of Intestinal Health at Maastricht University. ‘But the cause of these complaints is not only eating gluten, so a gluten-free diet isn’t the only solution.’

To treat this problem, the researchers want to conduct further studies on the influence of the brain on the development of bowel complaints. ‘For example, we’d like to know exactly which areas in the brain are involved,” says Jonkers, “and we also want to find out what substances play a role in the communication between the brain and the gut, and whether people might respond differently to them. It’s also quite possible that some people can’t tolerate wheat products because of substances in wheat other than gluten, and that there is indeed something in wheat that can lead to overstimulation of the immune system, for example, or excessive production of gas by the gut flora. This is also something we’d like to investigate.”

Source: Maastricht University

Categories : Injury & Trauma Pain ManagementTags :

Acute Back Pain is Easily Treated but When Recovery Slows, can Become Persistent

On By ModernMedia
Photo by Sasun Bughdaryan on Unsplash

A systematic review published in the Canadian Medical Association Journal revealed that while people had good odds of recovering from short term back pain, but if it becomes persistent, then the chances of recovery are greatly reduced. This has important implications for the treatment of chronic back pain, as it points to the pain from the original injury being replaced by pain hypersensitivity.

“The good news is that most episodes of back pain recover, and this is the case even if you have already had back pain for a couple of months,” University of South Australia Professor Lorimer Moseley says.

“The bad news is that once you have had back pain for more than a few months, the chance of recovery is much lower. This reminds us that although nearly everyone experiences back pain, some people do better than others, but we don’t completely understand why.”

The systematic review and meta-analysis, conducted by an international team of researchers, included 95 studies with the goal of understanding the clinical course of acute (< 6 weeks), subacute (six to less than 12 weeks) and persistent (12 to less than 52 weeks) low back pain.

For people with new back pain, pain and mobility problems lessened significantly in the first six weeks, but then recovery slowed.

This study filled a gap in a 2012 paper from the same research team, with new findings showing that many people with persistent low back pain (more than 12 weeks) continue to have moderate-to-high levels of pain and disability.

“These findings make it clear that back pain can persist even when the initial injury has healed,” Prof Moseley says.

“In these situations, back pain is associated with pain system hypersensitivity, not ongoing back injury. This means that if you have chronic back pain – back pain on most days for more than a few months – then it’s time to take a new approach to getting better.”

He notes that there are new treatments based on training both the brain and body that “focus on first understanding that chronic back pain is not a simple problem, which is why it does not have a simple solution, and then on slowly reducing pain system sensitivity while increasing your function and participation in meaningful activities.”

The authors state that identifying slowed recovery in people with subacute low back pain is important so that care can be escalated and the likelihood of persistent pain reduced.

Further research into treatments is needed to help address this common and debilitating condition, and to better understand it in people younger than 18 and older than 60 years.

Source: University of South Australia

Categories : Mental HealthTags :

Financial Stress Linked to Worse Biological Health

On By ModernMedia
Photo by Alex Green on Unsplash

People who experience stressful life events or circumstances are more likely to have worse biological health, as indicated by biomarkers involved in the interaction between our immune, nervous and endocrine systems, according to a new study by UCL researchers.

The study, published in the journal Brain, Behavior and Immunity, found that not only major stressful experiences such as bereavement but chronic challenges such as financial strain were detrimental to the healthy interaction of these systems.

Communication between our immune, nervous, and endocrine systems is necessary to maintain good health. Disruption of these processes is linked to a wide range of mental and physical illnesses, from cardiovascular disease to depression and schizophrenia.

When a threat like stress occurs, signals between the immune, nervous, and endocrine systems are activated and spur physiological and behavioural changes.

In this new study, the researchers analysed blood concentrations of four biomarkers in 4934 people aged 50 and over who were participants of the English Longitudinal Study of Ageing. Two of these were proteins involved in the innate immune response to inflammation (C-reactive protein and fibrinogen), and two were hormones involved in the physiology of the stress response (cortisol and IGF-1).

The team used a sophisticated statistical technique, latent profile analysis, to identify clusters of biomarker activity. Three groups were identified and labelled as low risk to health, moderate risk, and high risk. The researchers then looked at how earlier exposure to stressful circumstances might affect people’s likelihood of being in the high-risk group.

They found that exposure to stressful circumstances overall, ranging from being an informal carer to experiencing a bereavement or divorce in the last two years, was linked to a 61% increase in likelihood of belonging to the high-risk group four years later.

Separately, the effect was also cumulative, as the likelihood of belonging to the high-risk group increased by 19% for each stressor experienced, for those who experienced more than one stress-inducing circumstance.

People who reported only financial strain – the perception that they may not have enough financial resources to meet their future needs – were 59% more likely, four years later, to belong to the high-risk group.

Lead author, PhD candidate Odessa S. Hamilton (UCL Institute of Epidemiology & Health Care), said: “When the immune and neuroendocrine systems function well together, homeostasis is maintained and health is preserved. But chronic stress can disrupt this biological exchange and lead to disease.

“We found that financial stress was most detrimental to biological health, although more research is needed to establish this for certain. This may be because this form of stress can invade many aspects of our lives, leading to family conflict, social exclusion, and even hunger or homelessness.”

Experiencing stress over a prolonged period of time can disturb the communication between the immune and neuroendocrine systems. That is because our response to stress is similar to our response to sickness, activating some of the same pathways (for instance, both responses trigger the production of immune system signals called pro-inflammatory cytokines).

The researchers also looked at genetic variants previously found to influence our immune-neuroendocrine response and found that the association between stressful life circumstances and belonging to the high-risk group four years later remained true irrespective of genetic predisposition. 

Source: University College London