Medical Aid

 

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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The benefits on low blood pressure

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If you were born with blood pressure on the low side, that’s good news – but there are still a few things worth knowing about this condition.

Having low blood pressure in your genetic make-up means you don’t face the risk of developing heart problems or having a stroke as a result of high blood pressure. However, a sudden drop in blood pressure can indicate something more serious.

What is considered low blood pressure?

Low blood pressure, or hypotension, is a blood pressure measurement of 90/60mm Hg* or below. A normal or ideal blood pressure reading is between 120/80 and 90/60mm Hg. Blood pressure can vary considerably over short periods, depending on:

    • body position
    • stress levels
    • physical conditions
    • medication
    • diet
    • time of day – usually lowest while someone sleeps.

Most people with chronically low blood pressure aren’t even aware of it, and if you have
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Therapy For Breast Cancer Is No Longer Cut And Dried

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High-profile media campaigns have made most South African women aware that breast cancer poses a very real risk. But the message that really needs to be conveyed is that the disease can affect anyone and that most women who get breast cancer do not have risk factors.

In addition, more and more young women are presenting with breast cancer. “The implication for South African women is important: we should be taking proactive steps for women to be ‘breast aware’ from a young age. The earlier it is detected and treated, the better the prognosis,” says specialist surgeon and breast disease specialist, Professor Carol Ann Benn, who established the Netcare Milpark Breast Care Centre of Excellence.

International accreditation

The facility, which was the first breast care centre of excellence to be established in the private sector in South Africa some 16 years ago, has been granted a three-year, full accreditation by the National Accreditation Programme f
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8 Symptoms of Endometriosis Many Doctors Don’t Recognize

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Endometriosis is one of the least understood female conditions.

Despite the fact that roughly 1 in 10 women of reproductive age suffers from endometriosis (equivalent to 5 million women in the United States and 176 million women worldwide) very little is known about the condition (1,2).

Worse yet, about three-quarters of these women experience pelvic pain and/or painful periods as typical symptoms of endometriosis.

What is Endometriosis?

According to WebMD: “Endometriosis occurs when tissue that should line the inside of your uterus, the endometrium, grows outside of it instead. Even though the tissue is outside of your uterus, it still acts like it should during your menstrual cycles. That means at the end of your period, this tissue will break apart and bleed.”

“However, the blood from this tissue has no place to go. Surrounding areas may become inflamed or swollen, and scar tissue and lesions can develop. The most common site fo
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Disastrous antibiotic hazard from food

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The greatly excessive use of antibiotics in food production in recent decades has made many bacteria more resistant to antibiotics. The United States Department of Agriculture (USDA) has estimated that antibiotic use in animal husbandry, poultry farming and aquaculture in the US is over four times USDA recommended levels. Meanwhile, the US Food and Drugs Administration (FDA) has estimated that 80 percent of all antibiotics sold in the USA are used on animals.

Cheap antibiotics prone to abuse

Antibiotics are used to ensure better health and survival of animals bred for food, but they are also believed by many farmers to promote growth. As prices of antibiotics remain attractively low, they offer the prospect of higher earnings from greater output at low cost. Hence, there is little or no market incentive to reduce excessive, if not indiscriminate use, and hence the abuse of antibiotics. Thus, such efforts to increase farmer incomes and profitabili
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Demarcation regulations: In whose best interests?

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Are the demarcation regulations a means for the department of health to erode the private healthcare system in preparation for NHI, or is opposition to its implementation merely an attempt by insurance companies to protect their bottom line?

The Free Market Foundation (FMF) supports the theory of the former, using the argument that come 1 April, when the regulations kick in, 2m poor people will lose the only healthcare cover they can afford, namely primary healthcare insurance products.

“The final demarcation regulations show a blatant disregard for ordinary people’s right to access healthcare and are based on the unsubstantiated claim that health insurance products are harmful to the medical schemes industry,” it says in a statement.

Drawing a line in the sand between medical insurance products and medical schemes the regulations come into force on 1 April 2017 and eliminate existing policies from 1 January 2018.

Limited gap cover and hospital cash
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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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Oversupply of hospital beds contributes to healthcare inflation.

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Healthcare costs consistently outpace inflation. In South Africa, these costs are not regulated so it is pivotal for medical aid schemes to explore ways and means of decreasing costs on the supplier side, particularly with hospitals.

This is coupled with a private healthcare industry cost blow-out in 2016 (largely related to increased hospital admission rates) and an oversupply of private hospital beds, particularly in metropolitan areas. There are approximately four private hospital beds per 1,000 medical scheme beneficiaries in South Africa and this number is increasing.

Oversupply of hospital beds

“Some parts of the country have as many as six beds per 1,000 people. This is twice or three times higher than the ratio seen in efficient systems with good community-delivered healthcare services,” says Dr Brian Ruff, CEO of healthcare management company, PPO Serve.

For example, the UK has 2.5 hospital beds per 1,000 population and New Z
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Two major medial aid changes in 2017 that you need to know about

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The National Treasury has introduced two new The National Treasury has introduced two new medical scheme regulations which will see a limit on the amount of gap cover and hospital cash-back policies you can claim, as well as the discontinuation of all primary healthcare policies.

This is an effort to differentiate between “medical scheme products” and “health insurance”, both of which are regulated by separate Acts causing confusion in the medical arena.

The regulations, which were demarcated in terms of the Long-term and Short-Term Insurance Acts, will come into effect as of 1 April 2017 for new policies and retrospectively from January 2018 for existing policies.

Gap Cover and cash-back plans

The new regulations stipulate that hospital cash-back plans are limited to paying their clients a maximum of R3,000 per day, or a total lump sum of R20,000 per year. Currently there are no limits in place for these payments.

Gap cover policies will now als
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New medicines law will change rules on medical devices.

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When the amendments to the Medicines and Related Substances Act come into operation, it will result in significant changes to the regulatory regime currently in place.

According to guidelines issued by the department of health and Medicines Control Council (MCC), the new regulations will apply to the manufacturing, importing, exporting and distribution of medium- and high-risk medical devices.

Although proposed licensing requirements will apply to local companies, foreign manufacturers exporting to South Africa will also be affected. “As it stands, the MCC is only responsible for managing the introduction of medicines in all forms into the local supply chain,” says Graham Anderson, Profmed’s CEO and principal office.

Imported devices will also come under scrutiny

He says if the new rules come into play, all medical devices brought into the country will also be properly regulated. “The definition of medical devices in the proposals i
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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.”

Looking for a affordable Medical Aid or Hospital Plan, just click here Medical Aid or just
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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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