Posts tagged with 'healthcare costs'

 

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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Non-invasive scan for liver disease

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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
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Healtcare Services Delivery need to change in Africa

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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
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Dr Aaron Motsoaledi is clueless – NHI cannot work in SA – to push ahead with it, is an act of desperation

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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.

In Limpopo alone there is a backlog of 26 000 su
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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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480 narkotiseurs kan SA verlaat oor swak NGV

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Indien narkotiseurs meen dat die Nasionale Gesondheidsversekering (NGV) en die beoogde prysbeheer ’n bedreiging vir hul beroep inhou, kan tot sowat 480 of ’n derde van hulle die land verlaat.

Natalie Zimmelman, uitvoerende hoof van die Suid-Afrikaanse Vereniging van Narkotiseurs (Sasa), het Dinsdag op ’n mediakonferensie die uitslae van ’n peiling onder narkotiseurs oor onder meer die NGV bekend gemaak.

Sy sê narkotiseurs is ’n “hoogs sensitiewe en baie mobiele” arbeidsmag omdat meer as 40% van hulle ook in ander lande geregistreer is. Meer as 50% het reeds in ’n ander land gewerk.

“Hulle kan môre die land verlaat as hulle wil.”

’n Peiling wat verlede jaar vir die markondersoek oor private gesondheidsorg uitgevoer is se inligting is nou vrygestel.

Dit toon 35% of sowat 480 narkotiseurs oorweeg dit om in die komende vyf jaar die land te verlaat. Dit hou met sosio-ekonomiese bedreigings vir hul beroep en hul siening oor die gesondhe
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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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Nuwe gesondheidsorg in die vooruitsig

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Die afskaffing van bybetalings op mediese dienste is een van die aanbevelings van die voorgestelde wet op mediese dienste.

Volgens Aaron Motsoaelidi, minister van gesondheid, kan slegs 10% van die bevolking private gesondheidsorg bekostig en moet dit onmiddelik reggestel word.

Tussengangers gaan ook afgeskaf word om te verseker dat lede direk gelde aan die mediese fondse betaal. Die rykes moet nou die armes subsidieer en die jonger geslag moet die ouer geslag help en die gesonde mense moet die siek mense subsidieer. Hy sluit af deur te sê dat die oorskakeling ‘n massiewe reorganisasie van die totale gesondheidsorg stelsel  gaan wees, beide privaat en openbaar.

Medici sê mense sterf daagliks in staatshospitale, diefstal van mediese voorraad en toerusting is aan die orde van die dag.  Instandhouding van toerusting bestaan nie en personeel se betalings is agterstallig.  Die totale gesondheidsorg van die staat is in chaos en al uitweg is dat privaat mediese
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Best and worst medical aids in South Africa.

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The latest GTC Medical Aid Survey for 2016 has been released, which compares local medical aid schemes on price across various levels of cover.

According to the latest General Household Survey from Stats SA, only 17.5% of South Africans are covered by medical aid.

Between 2002 and 2015, individuals who were covered by a medical aid scheme increased from 7.3 million to 9.5 million persons.

According to the Council for Medical Schemes’ Annual Report, released in July 2015, 37.55% of all medical aid costs were in-hospital, followed by 23.51% from specialists of which less than 10% was attributable to out-of-hospital services.

This reflects a total of almost 61% of healthcare costs paid for by medical aids were for in-hospital procedures. Expenditure on all health benefits by medical schemes rose by 11.1% in 2014 to reach R124.1 billion.

The GTC makes an admission that trying to compare medical aid schemes in a comprehensive way is virtually impossible due
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TEMBISA Hospital in Ekurhuleni – patients often have to sleep on stretchers or mattresses on the floor

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TEMBISA Hospital in Ekurhuleni serves 2,5 million people and delivers 16 000 babies a year but only has 840 beds.

This was revealed yesterday by hospital CEO Dr Lekopane Mogaladi during an oversight inspection conducted by the DA.

Mogaladi said patients often have to sleep on stretchers or mattresses on the floor.

He said the hospital and a private partner had plans to open a prefab medical ward with 24 beds in August. The CEO said the hospital desperately needs 49 more nurses but the Gauteng Health Department has only given them permission to fill four posts.

Head of nursing Wilfred Mothwane said the hospital should have at least 623 more nurses.

“Some of the current nursing staff are going to retire soon. We deliver 42 babies daily with a limited number of midwives,” said Mothwane.

DA Gauteng shadow health MEC Jack Bloom said: “Tembisa would benefit if the health department expanded Edenvale Hospital and built a medical facility in Kempton Par
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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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