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.
Looking for a affordable Medical Aid or Hospital Plan, just click hereContinue reading…
Many private hospitals will be opening their doors to more patients but does that mean you’ll be stuck at the back of the queue?
The United Kingdom’s universal healthcare system, known as the National Health Service (NHS), had a problem: By the early 2000s, a growing number of elderly patients were waiting up to three years for sight-saving cataract services in the early 2000s.
But the government-funded healthcare scheme didn’t have enough beds. It did, however, have plenty of parking.
“All we needed was a parking lot and a connection to three-phase electricity,” remembers South Africa’s Netcare CEO Richard Friedland.
Netcare entered the UK market fifteen years ago. It operates more than 50 private hospitals in the country, but 43% of its patients come from the NHS through the service’s electronic “choose and book” appointment system: Patients elect where to go for care, and the NHS pays private providers like Netcare a nationally-set rate Continue reading…
After a four and a half year probe initiated by South Africa’s Competition Commission, a panel of independent experts released their preliminary report into the country’s private healthcare market.
The Conversation Africa spoke to Sharon Fonn, who was on the panel of experts, about the report.
Why was a market inquiry set up?
The inquiry was set up because private healthcare and medical scheme cover is expensive in South Africa. Costs continue to rise and fewer people can afford it. People who have health insurance find that the scheme covers less care and they often have to pay out of pocket. Continue reading…
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 Continue reading…
The latest iteration of the National Health Insurance (NHI) policy paper is no closer to defining how much the scheme will cost and where the money will come from to pay for it.
Meanwhile, SA risks running out of tax payers to finance its social security commitments, said Dr Johann Serfontein, senior healthcare consultant with HealthMan and Jasson Urbach, director & head of the Free Market Foundation’s Health Policy Unit.
The NHI scheme is based on a government administered, centrally controlled, single-payer model. Healthcare decisions will be determined by government from the cradle to the grave. NHI will reduce the number of available services, mean fewer healthcare providers and patients will face long waiting lists. NHI concentrates power in the hands of government and requires it to act as both player and referee, leaving no room for the private sector. Under NHI, whether directly or indirectly, government will control the availability, financing and Continue reading…
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.
NAIROBI – The generic version of the most advanced drug against HIV has been introduced in Kenya, a first in Africa where more than 25m have the disease, the NGO Unitaid said.
The drug, Dolutegravir (DTG) is the anti-retroviral drug of choice for those living with HIV in developed countries, but its high price has put it out of reach for most struggling with the disease in Africa.
“The generic DTG has two advantages: on the one hand, it is very good from a pharmaceutical point of view. On the other hand, it is much cheaper,” said Robert Matiru of Unitaid, which works to reduce the costs of medicines treating Aids, tuberculosis or malaria.
He described the drug as “the most effective HIV treatment currently on the market.”
A box of 30 pills of DTG, which lasts a month, costs between $25 and $50. The generic version only costs $4.
Kenya has already started rolling out the new drug, which will initially be provided for free to 27,000 people living with HIV Continue reading…
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.
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. Continue reading…
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.
In the past the only way to measure a liver’s elasticity was through a biopsy, but now, a non-invasive alternative has emerged, whereby elasticity of a patient’s liver can be measured using vibration-controlled transient elastography (VCTE).
Adopted as a frontline tool for assessing liver fibrosis by the European Association for the Study of the Liver (EASL) and by the American Association for the Study of Liver Diseases (AASLD), the FibroScan VCTE liver stiffness testing system generates a shear wave that travels through the liver and the speed of which is measured by ultrasonic signals. The stiffness of the liver is proportional to the speed of the shear wave.
Dr Naayil Rajabally, who has been using the system in his rooms since early 2016, says if the test reveals fibrosis, treatment can begin without any need for the liver biopsy in conditions such as viral hepatitis, non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease and cholestatic liver dis Continue reading…
Healthcare services delivery in Africa needs to change, but no-one is quite certain how. What is certain is that future trends will be driven by access to big data, to shape new models of care in driving innovative, affordable and accessible services, across this diverse continent.
With 1,2bn people, many enjoying a longer life, and the rise of non-communicable diseases (NCDs) there is a growing recognition of the importance of digital innovation in delivering curative and preventive care.
“The transition to digital healthcare offers opportunities to aggregate patient data from multiple sources – for example, from external healthcare providers and specialists who consult to the patient – to give them a single, accurate patient profile.
“This allows healthcare professionals to quickly connect all the dots in a patient’s care, with a view to focusing on optimum outcomes for the patient.In fact, a study in the Journal of Neurology found that putting a digital Continue reading…
Plans by the Minister of Health, Dr Aaron Motsoaledi, to push ahead with the National Health Insurance (NHI), is an act of desperation. It is a decision doomed to failure from the outset.
The minister is completely out of touch with the crisis in the South African public health system, and this was highlighted by his denial of a crisis despite the damning report from the commissioner of the Office of Health Standards Compliance (OHSC).
Recent presentations to the Portfolio Committee on Health by each of the provinces, the OHSC and the Auditor-General, painted a picture of a health system that has collapsed entirely. It is beyond a crisis, it has simply failed.
DA visits to hospitals and clinics around the country have exposed medicine shortages, equipment shortages and a severe shortage of beds. In most hospitals visited, infrastructure is collapsing and lack of maintenance in facilities is painfully obvious.
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 Continue reading…
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:
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