Posts tagged with 'medical scheme'

 

Kundiges in gesondheidsbedryf krap kop oor toename in hospitalisasie

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Kundiges in die gesondheidsbedryf het op die jaarlikse konferensie van die Hospitaalvereniging van Suid-Afrika (Hasa) in Kaapstad hewig van mekaar verskil oor wat die redes vir ‘n skerp toename in die koste van mediese skemas is.

Matthew Prior, hoof van gesondheidsbeleid van Life Healtcare, sê ’n toename in benutting van gesondheidsdienste word die afgelope jare as die hoofoorsaak beskou vir hoë mediese inflasie. Hy sê die premieverhogings wat mediese skemas van hul lede eis, is die werklike maatstaf van mediese inflasie vir verbruikers.

Prior het die debat gelei oor die redes vir die toename in die benutting.

Navorsing deur Medscheme, die administrateur van mediese skemas, toon daar is ’n verband tussen ’n toename in hospitaalbeddens en die skerp styging in hospitalisasie wat verlede jaar ervaar is, sê dr. Jenni Noble, hoofbestuurder van Medscheme.

Die mededingingsowerhede se paneel wat die markondersoek na die gesondheidsbedryf doen, het in 2016
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#HASA2017: NHI needs to start delivering now

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South Africa can’t wait for the final National Health Insurance (NHI) system in 2026 to start delivering on universal health coverage, but needs to start implementing projects and programmes that will make a real difference in people’s lives now. And this can’t be done without cooperation between the public and private health sectors.

This was the overarching message in a high-level panel discussion of chief executives from the private healthcare sector at the Hospital Association of South Africa (Hasa) conference currently underway at the Cape Town International Centre.

White paper is not enough

“NHI, in principle is the right thing to do, but implementation is the key,” said Vishal Brijlal, National Department of Health (DoH) advisor on NHI. “We have a white paper, but that is not enough. The policy needs to be followed by planning, implementation, and cooperation.

“We can’t just wake up on 1 April 2026 and hope by some miracle that NHI will be
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Nearly 2 million will lose private healthcare if tax reform happens

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The government’s plan to ditch medical aid tax credits will have a disastrous effect on already cash-strapped South Africans and force nearly 2 million people onto the over-stretched state health system.

If the tax credit is removed, 22% of medical aid users will not be able to afford cover, Stellenbosch economics consultancy Econex warned in a report published on Friday – 1.9 million of the 8 million medical aid members, including children, will have to drop out of the private healthcare system.

In a national health insurance policy document released in July, Health Minister Aaron Motsoaledi said he wanted to remove the tax credit to users, which amounts to R20-billion a year.

Medical aid schemes’ members get a tax reduction of R3,636 a year – or R303 a month. Motsoaledi said then that “the tax credit … we believe, is unfair”.

Economist Paula Armstrong, author of the Econex analysis, said the rebate was intended to “alleviate some pressure on the state [
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Robot-aided surgery now available in Eastern Cape Province

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The first robot-assisted surgeries to treat prostate cancer in the Eastern Cape were performed by Netcare Greenacres urologists Dr Hannes Brummer and Dr Johan Coetzee this week following the installation of the Da Vinci Si robotic surgical system at the hospital.

Similar robotic systems have been installed at Netcare hospitals in Cape Town, Johannesburg and Durban.

Coetzee and Brummer have been training in South Africa and Europe to perform robot-assisted surgery.

Netcare hospital division managing director Jacques du Plessis said that after robotic surgery systems had been introduced in other provinces there had been an increased number of referrals from other provinces.

“We have now brought the technology and capacity for robotic-assisted procedures to the Eastern Cape.

“We identified a need for the intricate and highly complex interventions the Da Vinci Si system enables trained surgeons to achieve,” he said.

Netcare Greenacres Hospital general man
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‘Beste’ mediese skema wen met eenvoud, waarde

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Medihelp is nou die mediese skema waarmee lede die meeste tevrede is.

Lede van mediese skemas is egter in die geheel beskou effens minder tevrede met hul produk as ’n jaar gelede.

Die tevredenheid van lede van Discovery Health Medical Scheme en van Bonitas het albei gedaal.

Dis onder die bevindings van die South African Customer Satisfaction Index (SAcsi) vir mediese skemas vir 2018, wat Donderdag uitgereik is.

Daarvolgens het die gemiddelde punt vir mediese skemas van 74,2 in 2017 tot 72,7 in 2018 gedaal. Dis uit ’n moontlike 100 punte.

Die grootste rede vir die daling is Suid-Afrikaners se “toenemende frustrasie met stygende premies en dalende voordele”. Hulle voel dat hulle minder waarde vir hul geld kry vergeleke met ander finansiële dienste, sê Schreuder.

Mediese skemas se premies het vanjaar met gemiddeld 9% gestyg, baie meer as waarmee kort- en langtermynversekering se premies gestyg het.

Oor Discovery, die grootste oop mediese ske
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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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NHI financing model questioned by FMF

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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
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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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‘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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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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