Posts tagged with 'medical aid'

 

‘Beste’ mediese skema wen met eenvoud, waarde

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Medihelp is nou die mediese skema waarmee lede die meeste tevrede is.

Lede van mediese skemas is egter in die geheel beskou effens minder tevrede met hul produk as ’n jaar gelede.

Die tevredenheid van lede van Discovery Health Medical Scheme en van Bonitas het albei gedaal.

Dis onder die bevindings van die South African Customer Satisfaction Index (SAcsi) vir mediese skemas vir 2018, wat Donderdag uitgereik is.

Daarvolgens het die gemiddelde punt vir mediese skemas van 74,2 in 2017 tot 72,7 in 2018 gedaal. Dis uit ’n moontlike 100 punte.

Die grootste rede vir die daling is Suid-Afrikaners se “toenemende frustrasie met stygende premies en dalende voordele”. Hulle voel dat hulle minder waarde vir hul geld kry vergeleke met ander finansiële dienste, sê Schreuder.

Mediese skemas se premies het vanjaar met gemiddeld 9% gestyg, baie meer as waarmee kort- en langtermynversekering se premies gestyg het.

Oor Discovery, die grootste oop mediese ske
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Doctors Sound Alarm That SA Mental Healthcare Is Collapsing

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While almost all the previous Life Esidimeni psychiatric patients have been transferred from the NGOs in Gauteng back into hospitals, a group of doctors have warned that the psychiatric structure in South Africa is collapsing.

Reports reveal that in some mental health hospitals there are no psychiatrists, and none of the provinces have organised community-based psychiatric services at present. The South African Society of Psychiatrists (SASOP) said even 150 days after the Health Ombudsman released a report, many hospitals were still facing a shortage of staff with minimal resources.

The president of the SASOP, Professor Bernard Janse van Rensburg, told Health24 that South Africa’s healthcare system is totally fragmented and broken. “Esidimeni was just the tip of the iceberg,” he said. At the beginning of this year, Health Ombudsman Professor Malegapuru Makgoba said the death toll of mentally ill patients who were transferred from Life Esidimeni to 27 NGOs w
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Ground Breaking operation: Youngest child in Africa gets mechanical heart

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A five-year-old KwaZulu-Natal boy made history when he became the youngest person in Africa to receive a mechanical heart implantation. In what is considered a ground breaking operation doctors from the Maboneng Heart Institute‚ at the Netcare Sunninghill Hospital‚ inserted a heart ventricular assist device (HVAD) into Mnotho Mndebele’s “severely damaged” heart which helps it..
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How will private healthcare evolve under Universal Health Coverage (UHC)?

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With National Health Insurance, the Competition Commission investigation and sky-rocketing costs, it’s no wonder that the private healthcare sector (and the public sector for that matter) is a tad wary about what the future holds.

However, in which ever way, shape or form it manifests itself, universal health coverage (UHC) is inevitable. It forms part of the United Nations’ sustainable development goals. “To promote physical and mental health and well-being and to extend life expectancy for all, we must achieve universal health coverage and access to quality healthcare. No one must be left behind. This places UHC as the target that underpins and is key to achievement of other Goal 3 targets.”

Set of goals

According to Dr Rufaro Chatora, World Health Organisation (WHO) country representative says UHC provides a set of goals rather than tell us how to organise a health system. “This is logical as each country faces different challenges
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Syndicates and devious health professionals may target National Health Insurance

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Criminal networks are targeting your medical aid rands but could you be part of the problem too?

Criminal syndicates and unscrupulous doctors may be defrauding the private health sector of millions as experts warn that medical schemes may reach a breaking point.

“The health care sector is being targeted by criminal syndicates and even devious practitioners. It is a direct threat to the financial viability of medical schemes in the country, including any National Health Insurance initiative we attempt,” says medical advisor on healthcare forensics at medical aid administrator and risk management service, Medscheme Gregory Pratt. Pratt was speaking at the Board of Healthcare Funders Southern African Conference this week in Cape Town.

“The affordability of medical schemes in the country will soon reach a tipping point.”

In 2013 alone, Discovery Health recovered R300 million in fraudulent claims alone – a number that in 2014 CEO Jonathan Broomberg told
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These are the cheapest and most expensive medical aids in South Africa

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The latest GTC (formerly Grant Thornton Capital) Medical Aid Survey for 2018 has been released, which compares local medical aid schemes on cost to members across various levels of cover.

South Africa’s medical aid industry is facing an uncertain time ahead with government recently pushing through two new healthcare bills that are set to shake up the entire system ahead of the launch of the National Healthcare Insurance (NHI) scheme.

According to GTC, there are still many lingering questions that need to be answered in term of government’s plans – with many risks in the proposed changes that could lead to higher costs for consumers who rely of private healthcare.

“The NHI and amendments to the Medical Schemes Bill are inevitable. The disparity between the have’s (some eight million members) and the have-not’s (some 45 million) is real and needs addressing. Government intervention is urgently required,” it said.

“It is however equally importa
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Anger over medicines supply scheme

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It is crucial for the Rev Isaac Harley to take his medication daily – it’s a matter of life and death really.

As a diabetic with a hypertensive comorbidity, he depends on his tablets and insulin to maintain his insulin levels and to manage his high blood pressure.

But it’s been one problem after the next, he told The Sunday Independent, since his medical aid recommended he use its pharmacy’s direct service to deliver his chronic medication to his address instead of claiming from a local pharmacy in his neighbourhood, Elsies River in Cape Town.

“On more than one occasion I’ve had to call to find out what had happened to my medicine.

“During one stint I had no medicines for two weeks because of delivery delays and I didn’t have funds so I had to borrow medication from my mother, who is also diabetic, and money from friends to get the other medication privately,” the 48-year-old said.

In a battle spanning several years, the Independent Community
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Hospital cash-back plans crimped by new law

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The demarcation regulations clearly distinguish between medical insurance products and medical aid schemes. For the consumer, this means that while limited gap cover and hospital cash-back plans will still be allowed, primary healthcare insurance policies will no longer be available. All existing policies will need to align with the regulations from 1 January 2018.

Affected markets

These regulations will primarily affect those between 20 and 35 years of age. The annual Council for Medical Schemes (CMS) report shows that children up to the age of 20 usually stay on their parents’ medical aid. Then you see a significant drop in the number of dependents between the ages of 20 to 35, and then the line goes up again. This is a clear indication that the young and healthy are exercising their freedom of choice to not have medical aid cover. This is the group that, until now, has often relied on hospital cash-back plans for catastrophe cover.
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‘Private healthcare not affordable, even for people who are supposedly rich’

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The findings of the Competition Commission’s Health Market Inquiry released today reveal what Health Minister Aaron Motsoaledi says he already knew – that private healthcare has become so exorbitantly expensive, even those on medical aid can’t afford it.

Moreover, the commission found – during its more than four-year-long investigation – that the market was characterised by high and rising costs of healthcare and medical scheme cover, disempowered and uninformed consumers, and a general absence of value-based purchasing.

“That private healthcare has become costlier and costlier has been proven today, some of us knew it long ago back in 2009 that private healthcare no longer affordable, even for people who are supposedly rich who are on medical aid can’t afford it,” Motsoaledi said at the briefing held in Sandton to announce the release of the much anticipated provisional report.

According to the inquiry’s chairperson, former Chief Justice, Sa
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The most expensive and cheapest medical aids in SA for 2017

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The latest GTC Medical Aid Survey for 2017 has been released, which compares local medical aid schemes on cost to members across various levels of cover.

According to GTC, medical aids are complicated schemes, and comparing them is an almost impossible task; however it has developed a review process that compares schemes across specific categories, rather than on specific services offered.

For its 2017 review, GTC screened 23 medical aids (22 open and 1 closed scheme) offering 144 plans.

The rankings in the GTC Medical Aid Survey are based on the concept of a total cost or a risk rating for each medical aid plan.

This risk rating is derived from a risk premium, which represents the premium paid monthly minus the allocation to what is known as the ‘savings’ or out-of-hospital account.

“This approach removes any differences in personal circumstances, priorities or behaviours that may influence an individual’ eventual healthcare costs,” the group said.

The savi
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You are paying more for less when it comes to medical aid, does it make sense. Here’s why.

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What are your chances of ending up in a hospital? Higher than you’d think if you are a medical aid member in a large city — and the reason reveals some never-before-seen truths about the country’s private healthcare sector.

A lack of competition within the private healthcare market is fuelling an epidemic of overtreatment — and mystery medical bills — in South Africa, the Competition Commission revealed on Thursday.

As part of a four-year investigation into private healthcare costs, the Competition Commission looked at hospital admission rates among patients treated in nine specialised areas of medicine. People who had insurance and lived near more hospitals were more likely to be admitted than people with similar conditions that lived farther away from lots of empty beds, the statutory body found.

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Genesis wins case on accounting for use of medical savings funds

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On Tuesday, the Constitutional Court ruled that all funds paid by members to their schemes should be considered as assets, regardless of their intended use.

Genesis medical scheme has won its legal battle with the Council of Medical Schemes over how to account for the funds in members’ medical savings accounts (MSAs), a development that has potentially far-reaching implications for both the industry and consumers.

This technical accounting point will make a material difference in the way schemes calculate their solvency ratios that measure gross income against reserves.

Treating MSA balances as assets means schemes’ reported solvency ratios will improve, because funds accumulated in MSAs will now be considered as part of a schemes’ reserves, said Insight Actuaries joint CEO Barry Childs.

This is important because better solvency ratios mean less pressure on schemes to increase premiums.

The judgment overturned a high court ruling that the council has us
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Vier maniere om jou mediesefonds-spaargeld te rek

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Ons gee verbruikers vier maniere om hul mediesefond-spaargeld te rek.

Gebruik generiese medisyne

As generiese medisyne beskikbaar is, is dit ʼn heeltemal aanvaarbare plaasvervanger vir handelsmerkmedisyne, tensy jou dokter dit spesifiek uitsluit. “Baie generiese medisyne is klone ─ dit kan deur die oorspronklike vervaardiger op dieselfde produksielyn gemaak word. Dis net die verpakking wat verskil,” verduidelik Merle Rakusin, ʼn gekwalifiseerde apteker by die Clickswinkel in Claremont.

ʼn Generiese middel moet “bioidenties” aan die oorspronklike handelsmerkmedisyne wees, wat beteken dat die volgende presies dieselfde moet wees:

  • aktiewe bestanddeel
  • sterkte
  • gebruik en uitwerking
  • wyse van toediening (byvoorbeeld ʼn pil, inaseming of vloeistof)
  • vermoë om binne die regte tydsverloop en in dieselfde mate die verlangde vlak in die bloedstroom te bereik
    toetsstandaarde

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Day hospitals: The answer to rising health costs?

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South Africans are faced with the constant increases in the cost of living and an ailing economy, forcing consumers to cut down on spending across the board.

For a small percentage of the population, healthcare costs are covered by medical aid, but only an estimated 16% of South Africans have such coverage while the rest rely on an already overburdened healthcare system. Continuing downward pressure on the economy is pushing even those with medical cover to either reduce it, or outright terminate their membership just to make ends meet, leaving more and more South Africans vulnerable.

While there are several factors contributing to the increase in private healthcare costs, including the volatile exchange rate and its impact on the cost of importing medical equipment, the rising costs of medication, doctors’ fees, the increasing average age of principal members on the schemes, the biggest culprit is private hospital costs.

According to the Council for Medical
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Medical fraud costs the country’s economy

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The phenomenon of suspiciously qualified or unqualified doctors opening shop in some township and attracting unsuspecting patients has become a concerning norm.

Discussions and debate are focused on state capture and its effect on the economy, but there’s another beast eating away at productivity, hurting the economy and undermining our health system. South Africa is open for medical fraud business.

Medical fraud manifests in two ways: bogus doctors in practice and bogus medical certificates issued to rob employers by keeping an employee away from work while earning a salary.

The phenomenon of suspiciously qualified or unqualified doctors opening practices in some townships and attracting unsuspecting patients has become a concerning norm. Just recently a bogus doctor was caught and arrested at his Mpumalanga surgery in front of patients, some of whom he had prescribed highly regulated schedule 4+ drugs.

These bogus doctors – and even dentists and special
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