Medical Aid

 

Do you really think you’re going to opt out of the NHI when it comes?

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1. Will you be able to say “thanks, but no thanks”?
If the National Health Insurance (NHI) Bill is passed in its current form, the NHI will be compulsory, regardless of whether you also belong to a private medical aid. So, opting out won’t be possible. The Bill says the NHI, which will be like a big, state-funded medical scheme, will be a free service, but it doesn’t tell us what benefits will be covered, how the scheme will be paid for or how much it will cost.

2. When will the NHI start, and, will it actually happen?
The NHI Bill says the scheme will be implemented in three phases — we’re currently in the second phase (2017 – 2022), during which NHI legislation has to be developed and the NHI fund has to be established. During the last phase, from 2022 – 2026, Cabinet has to approve “the mobilisation of additional resources” so that the NHI can start to buy healthcare services from both public and private providers
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NHI white paper issues raised – National Health Insurance

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The two fundamental issues with the new white paper on National Health Insurance (NHI) are a single payer fund and the nationalisation of private healthcare without compensation.

Single payer fund

In terms of the single payer fund, the white paper believes that the NHI can use bulk purchasing power to drive down the price of healthcare services. However, it then simultaneously declares that it will accredit medical service providers – public and private – and then set the prices at which they can sell their services to the NHI. It specifically states that it will deploy a “uniform reimbursement strategy” and that accredited service providers will not be allowed to deviate from that.

This raises a fundamental question. If the NHI is going to regulate the price at which the services are being procured, why does it need to use the bulk purchasing power of a single fund to reduce prices?

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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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16 Foods That Boost Your Immune System

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Elderberry
It’s an old folk remedy. This fruit is loaded with nutrients called antioxidants, and it may help fight inflammation. In some lab studies, an extract from the berries appears to block flu viruses. But scientists caution that more study is needed. You definitely still need to get a yearly flu vaccination!

Button Mushrooms
They give you the mineral selenium and the B vitamins riboflavin and niacin. That helps you in several ways. If you’re low on selenium, you may be more likely to get a more severe flu. Riboflavin and niacin play a role in a healthy immune system.

Acai Berry
Its dark color is a sign that it’s got plenty of nutrients called anthocyanins.
There isn’t any research that shows acai is good for any specific condition. But in general, antioxidants from foods are a key part of a healthy lifestyle.
Enjoy these berries in juice or smoothies, or try them dried and mixed with granola.

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Skok-voorbeelde van bedrog by mediese fondse aan die lig gekom

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Die gesondheidsorgbedryf is in die visier van misdaadsindikate en onderduimse praktisyns.

Dr. Gregory Pratt, mediese adviseur vir forensiese ondersoeke in die gesondheidsbedryf vir Medscheme, het op die beraad vir gesondheidsorgfinansiers in Kaapstad skokkende voorbeelde genoem van bedrog waarmee hy die afgelope maande te make gehad het.

Mediese bedrog is so algemeen “omdat dit makliker gepleeg kan word as ander finansiële misdade,” sê hy oor die sindikate wat die bedryf teiken.

Voorbeelde van bedrog die afgelope maande:

1. ’n Sielkundige wat in net 102 dae R4,3 miljoen geëis het, het glo 173 pasiënte op een dag gespreek.

2. ’n Dermatoloog het R112 000 vir net 67 minute in die teater geëis.

3. ’n Sindikaat van sielkundiges in KwaZulu-Natal wat in twee jaar R80 miljoen (sien regstelling) geëis het van een mediese fonds. Baie van dié eise was vals of erg oordrewe.

4. ’n Sindikaat van aptekers in Soweto wat in drie jaar meer as R100
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New Survey: Medical aid members have more choice

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In the battle for a slice of the private healthcare market, there has been significant growth in the number of medical schemes performing well across all sections of the medical aid spectrum. Whilst this means that members get more choice, it also makes the landscape increasingly complex.

The GTC 2018 Medical Aid Survey (MAS) analyses and rates medical aid schemes according to a standardised comparison and ranks the choices available to members.

When analysed purely in terms of premiums – the survey’s micro ranking – Fedhealth emerged as the medical aid which held the most top positions across all the classifications. Discovery was ranked in first place for the survey’s macro rankings, which analyses a medical aid’s overall ‘health’ and longevity in terms of factors such as its solvency level, membership growth, net healthcare result and member satisfaction. When combining both the GTC micro and macro rankings, Discovery claimed the highest number o
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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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Making vaccines ubiquitous is the key to cracking the cold chain challenge

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Over the years vaccines have prevented countless cases of disease and saved millions of lives. Infectious diseases like polio, measles, diphtheria, pertussis (whooping cough), rubella (German measles), smallpox, mumps, tetanus and rotavirus used to be common around the world. Today vaccines can prevent them.

Despite this, one in five children in the world aren’t fully protected by even the most basic vaccines. In addition, almost 20 million are at risk of contracting preventable diseases because they are under-vaccinated. As a result about 1.5 million children die every year from diseases that can be prevented by vaccination coverage.

One of the main reasons is that there are many rural areas in the world that don’t have reliable power supplies. Vaccines need to be kept at particular temperatures, usually refrigerated, to remain effective. Cold chain conditions aren’t possible without power. A cold chain is a temperature-controlled supply chain that runs fr
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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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North West Health MEC working to recoup Mediosa money

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The North West Health MEC, Dr Magome Masike, says the department is working towards recouping taxpayers’ money lost to mobile clinic, Mediosa.

“First, the company sent us an invoice of R24m out of the R30m pre-payment. We need to satisfy ourselves that the [work for] R24m has been done by going through the report, which goes up to the end of January 2018.

“Then we still need a report for February 2018, which covers the work done for the outstanding R6m. Until we satisfy ourselves with the work that has been done, we are not settled with Mediosa,” said the MEC.

According to Masike, the company recently sent out tow trucks to collect the mobile health units stationed at Madibogo in the Ratlou sub-district and Kagisano Molopo respectively.

With plans underway to recoup the lost tax money, Masike raised concerns about the claims made by Mediosa about the number of patients serviced.

“My concern is the number of people that Mediosa is claiming to have
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Meet The Robin Hood Of Medical Scheme Rip-Offs: Clawing Back Big Sums – For A Modest Fee

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An entrepreneur has come up with a clever way to tackle the beast of medical scheme rip-offs. Instead of joining the throng of service providers who are squeezing private scheme members for ever greater sums, this Robin Hood of the healthcare sector has identified a way to claw back thousands of rands – for a modest fee.

Independent journalist Ed Herbst, who has an unwavering instinct to uncover news at every opportunity, discovered this enterprise while chatting to a neighbour. The details of this service are too important not to share, he reckons, highlighting how tens of thousands of rands are being directed back to their rightful owners. In a nutshell, the doctor who has started this service has made it his business to cut through complexities and legal nuances and has exposed questionable practices in the process. He can do it for less than R400, all in, and has saved people from bad credit records and cut the additional stress that comes with trying to find
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How to choose a medical aid

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Most medical schemes have launched their benefits and contributions for 2017 and it is the time when you should be re-looking at your existing medical aid cover or, if you are wanting to join a scheme, investigating which one suits you best.

The medical aid landscape can be tricky to navigate so it is important to compare options and schemes to ensure you find a medical aid that works for you and your family’s health and is within your budget.

Dr Bobby Ramasia, Principal Executive Officer of Bonitas Medical Fund, helps guide you through choosing the best plan, whether it’s through the open market or through an employer.

If you are already on a medical aid scheme

Before you choose the best medical aid option, you need an idea of what your typical health care costs are.

You should also consider the following for you and your dependants over the past twelve months:

How much you spent on day-to-day healthcare expenses
Where you or an
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South African Medical Association takes issue with Competition Commission findings

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The South African Medical Association (Sama) believes that the Competition Commission Health Market Inquiry (HMI) provisional report is faulty in its findings, particularly that doctors increase demand for unnecessary services.

In a statement, the association says that in light of the fact that the investigation took almost four years to complete and runs to hundreds of pages, it is, on first review, somewhat disappointed in the overall analysis of the private healthcare sector.

Doctor-induced moral hazard

Sama is particularly concerned about the allegations that doctors increase demand of unnecessary services, including increased admissions to hospitals, says chairperson, Dr Mzukisi Grootboom.

Looking for a affordable Medical Aid or Hospital Plan, just click here Medical Aid or just send your Name, surname, age and email address to
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