Tag: medical aid

Categories : Medical IndustryTags :

What can South Africans Expect from Medical Aid Schemes this Year?

On By ModernMedia
Leo Dlamini – Bestmed CEO & Principal Officer

The medical aid industry is at a crucial turning point, driven by innovative technologies, and an ever-growing need for inclusive and affordable healthcare solutions.

According to Bestmed CEO and Principal Officer, Leo Dlamini, this sector is likely to witness the emergence of a more collaborative ecosystem as a result of partnerships between tech businesses, insurance companies and healthcare providers – those that offer an integrated experience – to align to shifting consumer demands.

“In fact, there are several pressure points that continue to challenge the industry,” says Dlamini. “Compliance, with its evolving regulations and policies, including those related to data protection and member privacy, are high on the list, along with balancing the budget within a tight economic environment remain key priorities.”

Increasing health costs

The cost of providing healthcare cover is increasing faster than the economic growth rate and the consumer price index (CPI) which renders medical scheme membership unaffordable for the majority of South Africans. “Balancing the rising costs of healthcare and affordability for members is delicate and critical aspect of a running a sustainable medical scheme,” adds Dlamini. “Driving the increase in costs of healthcare is also the utilisation rate (claims ratio) by the members. This is partly due to a rise in elective procedures post-COVID and the more aggressive clinical interventions. Much of this, we believe, is a consequence of people neglecting their regular health screenings, which is now translating into more serious health issues that require deeper intervention, more exploratory procedures and specialised treatment.”

The biggest cost driver in healthcare in 2024 continues to be hospitals, followed by specialists. “Although the number of hospital admissions are currently lower than they were in 2019/2020, the average cost of admission has risen substantially. This is why it is very important to establish collaborative ecosystems that are inclusive and beneficial to all stakeholders.”

Personalised prevention over cure

Now more than ever, consumers are demanding transparency, simplicity and responsiveness when it comes to their medical aid, says Dlamini, which means a focus on more digitally integrated platforms for easier access to service, information and support. “Digital health technologies, including telemedicine, AI-driven diagnostics and personalised medicine options are increasingly shaping the medical landscape, allowing for more efficient and tailored healthcare solutions.”

“There is also a growing trend towards preventive healthcare,” adds Dlamini. “Medical schemes are, therefore, focusing more on wellness programmes, health screenings and preventive measures to improve members costs and reduce downstream / future costs. This also includes recognising the importance of mental health, and providing broader coverage and services, which include access to counselling, psychiatric treatments and support programmes.”

Retaining control while innovating for the future

2024 will see Bestmed mark 60 years since inception.  Bestmed is South Africa’s fourth largest open medical scheme and the country’s largest self-administered entity.

“As we celebrate our 60th anniversary, it’s an opportune time to take stock of how we’ve fared thus far and what the future outlook is,” adds Dlamini. “Embracing technological advancements to create an integrated healthcare ecosystem, as well as focus on delivering innovative health solutions that are competitively priced are key.  Equally important is the ability to adapt our offering to the changing healthcare needs of our members whilst also maintaining our Personally Yours brand promise.”

Bestmed achieved over 20% growth rate over the last few years which Dlamini attributes to the organisation’s ability to retain existing members, attract new ones (members) with our value-for-money product offering as well as being responsiveness to members’ needs.  “As a self-administering medical scheme, we pride ourselves with being more agile and responsive to members whilst also ensuring that every interaction is not transactional but personal,” adds Dlamini.

As for healthcare advice this year, Dlamini urges consumers to take control. “Do not neglect regular screenings, particularly as you grow into the senior years. Committing to these does not only prove life-saving, but also ensures that your money is not consumed unnecessarily and that your medical scheme is able to safeguard your contributions (reserves) to cover future medical expenses. Make sure that every procedure recommended is necessary and relevant to your condition.”

“It is going to be a tough year as economic growth remains flat and disposable income under sustained pressure from high interest rates and inflation.  The national election and the outcomes therefrom will most likely impact all of us in some form or other.  As medical schemes we must remain focused on providing value–for–money from our offerings and actively working to improve the health of members,” concludes Dlamini. 

Categories : Healthcare Politics and RegulationsTags :

Mediclinic and Discovery Sound Warnings over NHI Bill

On By ModernMedia
Photo by Markus Winkler on Unsplash

Private hospital group Mediclinic has warned that the government’s proposed National Health Insurance (NHI) system will threaten public health in South Africa, and bring about the destruction of private healthcare and medical aid cover.

The NHI Bill is currently undergoing a public consultation process, with a number of healthcare, civil society and political groups presenting on why the new system should or should not be introduced.

The Bill as it stands will have a direct impact on access to healthcare services in South Africa. Mediclinic notes that there are insufficient resources to implement it; private-sector hospitals will be curtailed; and medical aids will be eroded.

The financial and human resources necessary to effectively implement the NHI scheme is a legitimate concern, Mediclinic said. It pointed out South Africa’s low doctor- and nurse-to-population ratios are low compared to peer countries.

“Everyone’s right of access to health care services would be threatened if the existing health care delivery system is uprooted and the NHI scheme envisaged in the Bill cannot be effectively implemented,” it said.

Private healthcare is an integral part of the healthcare system with everything from hospital beds to staff at risk if replaced by the NHI.

The Bill’s key components threaten the private hospital sector, with the contracting and reimbursement frameworks proposed in it unable to accommodate private hospital participation.

Additionally, the NHI Fund will create a monopoly by acting as the single purchaser of health care services in South Africa, capable of harming the competition and eroding private sector resources.

Medical scheme provider Discovery said that current private health care funding amounts to R212 billion, some 44% of the total healthcare spend. If the government were to finance this through direct taxation, this would equate to 4.1% of GDP, an unfeasible amount.

Mediclinic also warned that medical aid in South Africa would be significantly eroded under the NHI, meaning only the bare basics for South Africans needing medical care, and expensive treatments being unavailable. It gave the example of a patient with chronic renal failure receiving haemodialysis treatment currently covered by a medical scheme, and showed that the patient would be placed on a long waiting list for this life-saving treatment since it was covered (but not properly funded) by the NHI.

Source: BusinessTech

Categories : CancerTags :

Unemployed People Missed Out on Cancer Screenings

On By ModernMedia
Source: National Cancer Institute

In a recent study, unemployed individuals in the US were less likely to have health insurance and be up to date on getting recommended cancer screening tests. Analyses published in the journal CANCER revealed that their lack of health insurance coverage completely accounted for their lower screening rates.

During the COVID pandemic, unemployment rates in the United States have risen to levels not seen since the Great Depression. To examine associations between unemployment, health insurance, and cancer screening, Stacey Fedewa, PhD, of the American Cancer Society, and her colleagues analysed information from adults under age 65 years who responded to a nationally representative annual survey of the general population.

Unemployed adults were four times more likely to lack insurance than employed adults (41.4% vs 10.0%). A lower proportion of unemployed adults had received up-to-date cervical (78.5% vs 86.2%), breast (67.8% vs 77.5%), colorectal (41.9% vs 48.5%), and prostate (25.4% vs 36.4%) cancer screening. These differences were eliminated after accounting for health insurance coverage.

“People who were unemployed at the time of the survey were less likely to have a recent cancer screening test and they were also less likely to be up-to-date with their cancer screenings over the long term. This suggests that being unemployed at a single point in time may hinder both recent and potentially longer-term screening practices,” said Dr. Fedewa. This can increase a person’s risk of being diagnosed with late-stage cancer, which is more difficult to treat than cancer that is detected at an early stage.

“Our finding that insurance coverage fully accounted for unemployed adults’ lower cancer screening utilisation is potentially good news, because it’s modifiable,” Dr Fedewa added. “When people are unemployed and have health insurance, they have screening rates that are similar to employed adults.”

The findings highlight insurance coverage’s importance in access to recommended cancer screening tests and indicate that insurance needs to be extended to all people, regardless of their employment status.

Source: Wiley

Categories : Medical IndustryTags :

Council for Medical Schemes Recommends a Limit on Contribution Hikes

On By ModernMedia
Image by Cottonbro on Pexels

In a circular sent to medical insurance schemes this week, the Council for Medical Schemes (CMS) has recommended that contribution increases be limited to 4.2% in 2022.

The regulator said that this would be in line with the projected Consumer Price Inflation (CPI) increase.

“In instances where it is economically feasible to implement a lower contribution increase than the CMS recommended CPI-linked rate, Trustees are encouraged to adopt innovative pricing models, subject to an independent actuarial evaluation,” it said.

“The CMS is also cognizant of the heightened uncertainty regarding the impact of the pandemic on healthcare claims costs, as well as how quickly member’s health-seeking behaviour will normalise.

“As such, pricing decisions for the 2022 benefit year should be largely data-dependent and sensitive to the demographic risk profile and financial position of each scheme.”

There are roughly 4 million medical scheme members, with almost 9 million beneficiaries. This represents a little more than one in seven of South Africa’s population of nearly 60 million.

Claims may spike

Some medical schemes may experience sudden spikes in high-cost claims as the pandemic progresses over coming months – though the final economic impact of the pandemic remains uncertain, the CMS said. The schemes’ demographic risk profiles, the size of the population covered, and the extent of existing cross-subsidies within benefit options or schemes will affect the impact.

Additionally, the financial position of each medical scheme prior to the pandemic will dictate how it is able to absorb high-cost claims from the pandemic, it said.

Pent-up demand

The CMS said schemes should also be cautious of pent-up demand as South Africans aim to make use of their medical aids as concerns around COVID decrease. As treatments for some minor medical conditions were postponed, with increasing vaccination rates, many of these conditions would now require more complex and expensive treatment. The CMS also noted that some healthcare services will be completely forgone, resulting in lower than projected claims costs.

“Studies also indicate that as countries move out of different Covid-19 waves, hospital visit volumes slowly recover, although the utilisation rates of different services remain well below pre-pandemic levels.”

Source: BusinessTech