Posts tagged with 'medical scheme'

 

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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Making Sense of Medical Aid Rates and Tariffs

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The medical aid industry is known for confounding consumers with all sorts of complex terms. Among the most confusing of all are references to medical aid, or medical scheme, rates.

Schemes and plans are quoted as covering the costs of in-hospital procedures up to 100%, 200% or 300% of the scheme rate or tariff. You might reasonably think this means that medical aid will cover all healthcare expenses, up to 100% or more. However, this is far from the case.
In this article, we focus on medical aid rates, how they’re calculated and what impact the different tariff options have on medical aid members.
The truth about medical tariffs
Medical expenses in South Africa are not regulated. Doctors, specialists and hospitals can charge what they want, provided the fees are deemed to offer “fair value” to the consumer.
The Department of Health has, however, published a list of recommended tariffs pertaining to specific treatments and procedures conducted i
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Climbdown on medical aids

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The Department of Health has done a U-turn on its plan to scrap medical aid schemes, saying they should work with the state when it rolls out National Health Insurance instead.

Department director-general, Precious Matsoso, met leaders of the medical aid plan sector and asked that they work together to reform healthcare in South Africa.

“This is big news,” said Graham Anderson, principal officer of Profmed. The medical aid sector was delighted to be asked to work with the department, because it had been in the dark about NHI for some time, he said.

In the meeting Matsoso made different suggestions on how the government may have to work with the private sector, such as subsidising medical aid options for people who couldn’t afford them.

Finer details of a partnership, however, were not discussed.

Matsoso confirmed the meeting.

She said: “The Department of Health is consulting all stakeholders, private, civil society and labour, to get further inputs [o
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Is your GP contracted in to a medical scheme network?

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If GPs are contracted in to a medical scheme network, they might be pressurised to recommend cheaper treatment options and medications, say SA health bodies.

The Board of Healthcare Funders (BHF) and the IPA Foundation (IPAF) is extremely concerned at the comments made recently by the Health Professions Council of South Africa concerning Designated Service Providers (DSPs).

The HPCSA recently released a statement to the effect that healthcare practitioners should be cautious when concluding designated service provider (DSP) agreements with medical schemes as the medical schemes attempted to reduce costs by applying pressure on practitioners within a DSP network to prescribe medication or recommend treatment options, when other more appropriate, albeit more expensive, options were medically indicated and readily available.

Pushing healthcare costs down

In the current environment where there are no regulated tariffs for healthcare procedures,
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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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Is dental healthcare as affordable and accessible as it should be?

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Oral health is essential to optimal overall health and minimising the probability of developing serious oral health conditions or infections in future. Yet, besides the fear factor, why are so many people reluctant to visit the dentist? “The underlying factors here include resources, socio-economic circumstances, accessibility and education.” “One of the biggest culprits for keeping..
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KPMG-skandaal raak ondersoek na duur medies

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Private hospitaalgroepe maak beswaar daarteen dat KPMG die Mededingingskommissie met sy navorsing gehelp het. ’n Kompromis is nou bereik wat die hospitale toegang tot die navorsing gee. Die KPMG-skandaal pootjie nou ook die markondersoek na die private gesondheidsorg. Die voorlopige bevindinge van die ondersoek moes die afgelope week bekend gemaak word nadat dit verskeie kere..
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So kies jy die regte mediese plan vir jou

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Hospitaalplanne, omvattende dekking, netwerkopsies . . . Besluit watter opsie vir jou die beste is. As jy lid is van ’n mediese fonds, het jy tot 15 Desember kans om jou voordeleopsie vir 2018 te verander. Oorweeg jou gesin se omstandighede: Hoeveel is julle; hoe is jul gesondheid; wat kan jy bekostig? Besluit dan watter..
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What’s driving up our healthcare costs?

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Discovery Health CEO explains why South Africans are paying higher medical aid premiums than ever before. Access to quality healthcare at an affordable price is a critical priority for every family, and in society at large. South Africans lucky enough to afford private healthcare have rapid and convenient access to some of the best quality..
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Cancer treatment waiting times in KZN increase by almost 30% as services stall

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Cancer patients are waiting up to nine months for treatment, says the South African Human Rights Commission. KwaZulu-Natal cancer patients are now waiting nine months for treatment, alleges Democratic Alliance spokesperson for health in KwaZulu-Natal Imran Keeka. In a statement, Keeka said South African Human Rights Commission (SAHRC) chairperson Bongani Majola revealed this new information..
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Medical aid waiting periods and late-joiner penalties: What. How. Why?

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The world of medical schemes in South Africa is a very different one to 25 years ago. There are strict rules and regulations governing the industry, there to protect both the members and the financial sustainability of the scheme. Now is the time of year when medical schemes announce their annual increases and benefit changes…
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Mediese selfbetalings styg met skokkende 13,4%

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Die brood het gekrimp, maar ons betaal nou meer daarvoor. Só het ’n ekonoom die verhoging van meer as 13% in selfbetalings deur mediesefondslede die afgelope jaar beskryf. Verbruikers wat elke jaar swaar trek aan die premies vir hul mediese fondse het boonop nog verlede jaar R29,7 miljard uit hul eie sak opgedok. Dit is..
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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..
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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..
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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..
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