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Public comment open soon for The National Health Insurance Bill of 2018

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The National Health Insurance (NHI) Bill of 2018 will be published in the Government Gazette shortly for public comment.

A key provision of the bill will be the establishment of an NHI fund to pay for health services so that all South Africans have access to quality care.

“The bill seeks to establish the NHI Fund of South Africa, as a public entity, so as to provide for a sustained universal health access that is affordable and of high quality. It also sets out its functions, powers and duties,” Cabinet said in a statement following its regular fortnightly meeting.

The bill provides a framework for the active purchasing of health care services by the fund on behalf of users and creates mechanisms for the equitable, effective and efficient use of the resources of the fund to meet the health needs of users.

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With winter around the corner, you need to know what flu really feels like !!!

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You’re sneezy, stuffed up, and feel bad all over. Is it a cold, or do you have the flu?

The symptoms can be a lot alike. But if you know the warning signs of the flu, you can get treatment quickly and work on feeling better, sooner.

What You Need to Know

Unlike a cold, flu symptoms usually come on suddenly. Another key difference is a fever, which might not happen with a cold. You might also have:

– Severe aches in muscles and joints
– Pain and tiredness around your eyes
– Weakness or extreme fatigue
– Warm, flushed skin and red, watery eyes
– A headache
– A dry cough
– A sore throat and runny nose

Adults with seasonal flu don’t usually vomit or have diarrhea, but children might.

Some symptoms can mean your illness is severe. Get immediate medical help if you have any of the following:
– Trouble breathing or shortness of breath
– Pain or pressure in your chest or belly
– Sudden
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The case for a restricted medical scheme

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With the sustainability of medical schemes coming under increasing scrutiny, many companies may be left wondering whether offering restricted medical scheme membership to their employees is still a viable benefit.

Restricted membership medical schemes – those not open to the public and where membership eligibility is dependent on working in a certain industry sector, company, professional association or trade union – are gradually giving way to the larger open membership schemes that anyone can join.

That being said, restricted medical schemes have again achieved the highest scores in the Alexander Forbes Health Medical Schemes Sustainability Index released in January. SAMWUMED and Polmed (the top scorer for the third consecutive year), were once again top performers in the index.

It is evident that by pooling together certain individuals, restricted medical aids are able to better manage their risk exposures in some instances, collect premiums more easily f
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Desperately seeking: A viable healthcare payment system

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South Africa’s private healthcare sector is under severe pressure, particularly with rampant inflation tracking at rates higher than CPI, creating a system that will eventually, in the not too distant future, become unsustainable.
In fact, at the end of last year, most of the country’s medical aids announced double-digit premium increases for 2017.

“Issues that are blamed for the high cost increases include; advancement in medical technology, cost of importing medical technology, administrator fees, broker fees, supplier induced demand, member over use, aging profile of medical scheme and therefore higher claims ratios, increased rate of illness in populations, legislative changes, incentives in the system.
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What to consider when deciding on a medical scheme

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Are your health insurance costs too high? Try decoding your medical aid terms and conditions and associated costs to make sure that it works for you.

“While health insurance is important, it comes at a cost that is rapidly rising. Unfortunately for the consumer, this affects medical scheme membership contribution rates, and the increases of which are sometimes significantly higher than general inflation.

As schemes try to contain their costs in the face of increasing claims, they make changes to their plans and benefits, which can come as a surprise to the consumer,” says Mark Payne, CEO of the Independent Community Pharmacy Association (ICPA).

Annual review of your plan

He recommends that an annual review of your plan is absolutely vital, and will affirm that it is serving your needs rather than the other way around.

The ICPA advises on several important things you should look at when considering a new medical scheme or reviewi
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Medical aid members still have to dig deep in their pockets

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Despite having medical aid, many members still have to fork out chunks of money out of their own pocket for healthcare products and services.

“In South Africa, healthcare services and products is provided by parallel running public and private healthcare systems. Even though private healthcare is only available to a very small section of the South African society (16,3%), it still accounts for a disproportionate 52% of the total expenditure on healthcare,” says Dr Jaco van Zyl, medical executive at Cipla SA.

In the private healthcare market the two main methods of financing is through medical schemes and direct out-of-pocket payments by the patients, paradoxically most of the latter are made by medical scheme members.

Medical schemes

Despite policy initiatives aimed at structuring affordable low cost healthcare funding products, medical schemes have remained unaffordable, and therefore inaccessible, to the majority of South Africans over the last couple
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Are Medical Scheme Members aware of what they are paying for?

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The medical scheme industry is full of jargon and benefit structures that often leave the man on the street confused and frustrated when it comes to understanding and accessing their benefits.

Medical schemes have in recent times attempted to simplify terminology to make it more understandable, but are they doing enough to ensure members know what they are paying for?

A recent survey among Resolution Health Medical Scheme (Resolution Health) members revealed that 87% of respondents felt that they generally understood the benefits they were entitled to on their specific benefit option, while 13% said that they found their benefits more than a little confusing.

This is a worrying statistic says Mark Arnold, Principal Officer of Resolution Health, as it means that a large number of members are not receiving advice from a healthcare broker when it comes to choosing their healthcare option, and may lead to members not having the level of cover they need.

The sur
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Why medical aids are so expensive.

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Healthcare is complex. Our bodies are the most complex machines we know of, and our brains and minds work in ways we do not yet fully comprehend. Despite rapid advances in medicine it remains an imperfect and growing science. This article unpacks just some of the mysteries of the healthcare system.

When health problems arise – whether medical emergencies or the development of a chronic condition – treatment costs can be extremely expensive and often too much for a typical household’s income. The solution to this is the pooling of funds earmarked for healthcare expenses so that subsidies exist between the healthy and the sick and between people at different income levels.

This happens in different ways in different environments. In South Africa, healthcare expenditure for the majority of the population is funded through a portion of general taxes collected.

For those who prefer treatment from so-called private providers, and can afford the premiums (either
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Why healthcare is so expensive in SA

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Some of the most significant contributors to soaring healthcare costs are fraud, waste and abuse. These are difficult to detect, monitor and prevent because the perpetrators are at every level of the delivery chain from healthcare providers at the top to policy holders at the bottom with many abusive acts playing out under the radar, for months, even years.

“It is estimated that healthcare fraud costs the sector between 5% and 15% of total pay-outs,” says Lynette Swanepoel, healthcare and insurance forensic specialist at the SA Fraud Prevention Services (SAFPS).

“Fraud is definitely a serious element, but on top of that the healthcare industry also has to contend with waste and abuse of benefits,” she says. One example of healthcare fraud is collusion between the policy holders and healthcare service providers such as doctors and pharmacists, where some doctors or pharmacists will supply non-covered items such as toiletries and baby products, falsely clai
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Over 200 Persecuted White South African Farmers Have Applied for Refuge in Australia

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South African Genocide

More than 200 farmers from South Africa have applied for humanitarian visas in Australia after suffering attacks for being white, according to the Australian Home Affairs Ministry…
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Tax claims for your Medical Expenses

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Putting in a claim for your medical expenses can be tricky when filing your tax returns.

I’d like to know if one can claim for medical expenses:

1. If medical aid doesn’t cover for the expenses paid; and

2. What if medical aid is exhausted and I pay out of my pocket, can I claim for that as well?

Piet Nel from the SA Institute of Tax Professionals responds:

The issue is whether or not it is qualifying medical expenses as defined in section 6B for purposes of the medical rebate.

We accept that, if the individual was a member of a medical scheme, it may not have been covered in full. This may be because this is something which is elective and not usually covered by the medical schemes or because it exceeded the value of the amount covered by the scheme.

It may also not qualify as a “relevant health service” in terms of the definition in the Medical Schemes Act, 1998. The Income Tax Act, however, doesn’t refer to this.

The section
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New Act could redress medical scheme sustainability issues

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Health Minister Aaron Motsoaledi has hinted at a number of reforms that directly address challenges of sustainability that the medical schemes industry is currently facing.

“We know that rising costs in healthcare are outstripping inflation, and legislated steps to address this are overdue. The proposals will usher in a new set of rules for how medical schemes operate,” says Mark Arnold, principal officer of Resolution Health Medical Scheme.

“While the details of how uniform tariffs for healthcare providers will be arrived at are not expected to be addressed in the Medical Schemes Amendment Bill, but rather will be informed by the outcome of the Competition Commission’s Health Market Inquiry, this is an important step towards protecting healthcare consumers.”

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15 Facts You Should Know About Open Medical Schemes

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How much do you really know about the inner workings of your medical scheme? Here are some quick facts on open medical schemes in SA.

Whereas each scheme will readily provide you with the facts on themselves, not everyone has the time or the patience to do a comparative study. Fortunately, Alexander Forbes Health has done it for you in their Diagnosis 2016/2017. Some additional information comes from the Council of Medical Schemes
Find out here what the facts are on open medical schemes in South Africa:

Since the year 2000 to the present, the number of open schemes in South Africa has decreased by 24 from 47. There are now 23 open medical schemes in SA, to which anyone can belong. Many smaller schemes have amalgamated, making them less prone to market volatility. The bigger the scheme, generally, the more financially stable. A small open scheme can be derailed by a couple of large claims, but that doesn’t happen so easily to a bigger scheme.
During 2016, Boni
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What does the law say about Medical negligence claims?

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Medical negligence can take place in so many ways, and as a result it sometimes appears impossible for the ordinary man on the street to know when and for what he may claim. In this article we highlight a few examples of possible negligence claims and the different forms of damages that can be claimed in each instance.

Example 1:

Mrs Y – an elderly woman admitted to hospital for the treatment of an airway infection, is recuperating after a theater procedure. A hospital staff member had phoned Mrs Y’s husband and requested that he give telephonic permission for his wife’s heart moisture to be removed. He did not doubt in the medical experts’ advice and gave his permission. The procedure was performed under anesthesia. Later that same afternoon Mrs Y’s family members were informed that a mistake was made. She should never have undergone the procedure as it was in fact intended for another patient.

After closer investigation it was reve
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Expropriation, AfriForum reaction to Ramaphosa’s statement

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Expropriation, AfriForum reaction to Ramaphosa’s statement

AfriForum response in reaction to President Cyril Ramaphosa’s statement that those who would like to mobilise the international community against “their own country”, should “come back home for inclusive dialogue”, is that the President should not confuse South Africa’s interests with the ANC’s policies.
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