Posts tagged with 'medical schemes'

 

National Health Insurance will cost more than R350 billion:- Solidarity

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“VAT will effectively have to be doubled,” says Solidarity. The Solidarity Research Institute has released a report detailing the enormous amount of funding necessary to effectively implement the National Health Insurance (NHI) scheme.

The numbers far exceed those previously calculated by the Health Minister, Aaron Motsoaledi. What’s more worrying is the heavy impact this will have on South African taxpayers.

According to Solidarity researcher, Morné Malan, funding required by the NHI is closer to R357 billion with a deficit of approximately R210 billion.

NHI: How does it affect the taxpayer?
Malan outlined the exorbitant fees which would need to be carried by the South African taxpayer. According to his research, value-added tax (VAT) would effectively double in order to carry the weight of NHI.

Commenting on the burden taxpayers will be forced to carry, Malan said:

“It is very difficult to determine from where the additional mon
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Need to know information:- What to look out for when choosing a medical scheme

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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.

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New fears about medical aid law changes may cause ‘doctor drain’

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A key issue of the proposed Medical Schemes Amendment Bill is the impact on doctors, resulting from a proposed uniform tariff for healthcare services.

Concerns have been raised about the proposed Medical Schemes Amendment Bill, one of many health-related bills which have been going through various motions in Parliament.

Recently, the cabinet approved the Bill to regulate medical schemes, and it will now be published and made available for public comment.

Among the concerns raised is the impact of a proposed uniform tariff for healthcare services, leading to a possible exodus of doctors and other healthcare professionals to countries where they can get “full value” for their services by charging tariffs they see as reasonable.

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The NHI debate is stuck in the weeds

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The National Health Insurance (NHI) is not a radical shift to dismantle a functioning system, but an opportunity to review two poorly functioning ones.

The public sector sees very high volumes of patients but gives them bad service and produces very poor outcomes. The private sector is modelled on low volume, high cost care – it uses its huge quantities of resources badly, to service very few people.

As the Health Market Inquiry (HMI) report makes clear, the large commercial medical schemes are resisting needed reforms that with better productivity would lead to the convergence of the two systems. In particular, they persist with an outdated tariff system that pays for services not outcomes and doesn’t support team-based delivery models. This is probably because it threatens their claim payment and ‘managed care’ role that justifies a very high income. This strategy is counterproductive for their members.

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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 13,4%, of ’n hele R2,5 miljard, meer as die vorige jaar, toon die jongste jaarverslag van die Raad op Mediese Skemas (RMS).

Boonop word dié syfer onderskat omdat dit net bereken word op die rekeninge wat lede indien waarvoor hulle self betaal het.

Die selfbetalings is die bedrae waarvoor geëis is wat fondse nie betaal nie.

“Dit kan ’n onderskatting wees van die werklike bedrag wat self betaal word omdat lede nie altyd hul eise aan hul fondse stuur wanneer hul voordele opgedroog het nie,” het die RMS in die verslag gesê.

Johann van Tonder, ’n ekonoom en navorser vir Momentum, het gesê mediese inflasie meet nie die styging in bybetali
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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 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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MEDICAL AID PREMIUMS SET TO INCREASE IN 2019

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Medical aid schemes have announced that the premiums paid by members are set to increase in 2019.

Talk Radio 702’s Xolani Gwala spoke to Paresh Prema, general manager of the benefits unit at Council for Medical Schemes, about what medical schemes consider reasons for increasing the premiums.

Prema says the responsibility of the council is to look at the suggestions put forward by the medical schemes and approve them before they can be implemented.

“So what you have seen, it is actually the submissions that they have made to us for the increases for next year.

“We look at the different elements that make up a contribution. The most important element is the claims and services that are paid for by medical schemes and how much it will be going up by in the next year.”

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Free Medical-Aid, Hospital and Funeral Plan and Insurance Quotes at www.MedSure.co.za
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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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HPCSA warns against global fee agreements.

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The Health Professions Council of South Africa (HPCSA) has urged healthcare practitioners to consult the council before signing any global fee or other financial or clinical arrangement with medical schemes, because these may violate the HPCSA’s ethical rules.

Since issuing a media statement in April warning against the practice, the council has been engaging with practitioners and different stakeholders since 16 May 2017 through roadshows held in Johannesburg, Durban, Cape Town and Bloemfontein and different meetings held with role players in global fee arrangements.

During the consultative process, the HPCSA has discovered that the alternative re-imbursement models are not limited to global fee arrangements and have advised its members not to enter into these contracts until all aspects relating to the law, ethics, clinical autonomy and funding mechanisms have been properly canvassed with all stakeholders

“While Council continues with a consultative proc
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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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Experts decry plan to consolidate small medical schemes !!

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The plan by the Council for Medical Schemes (CMS) to consolidate or dissolve small medical schemes posed risks to the people who belong to these schemes and might force some to drop their cover, industry sources warned this week.

More than 228,000 people belonged to 31 medical schemes that had fewer than 6,000 members at the end of 2015, according to the CMS 2015-16 annual report. All but three of these schemes are restricted employer groups. Restricted employer group schemes generally subsidise members on low incomes, enabling them to buy cover they could not afford on the open market.

CMS acting registrar Sipho Kabane said consolidating the industry was in line with the white paper on National Health Insurance (NHI).

Medical schemes with fewer than 6,000 principal members were targeted as they fail to meet the requirements of the Medical Schemes Act. The act says schemes must have 6,000 members to register.

Consolidation was necessary because fragmented r
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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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The big question:- Why South Africa needs to discipline the private healthcare industry

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If a service is provided by a company rather than government, this does not automatically mean a market is at work. The point is fairly obvious but has passed many in South Africa by.

Private provision of services is moving into the spotlight in South Africa as the government looks to make the health system more accessible to the poor. One aspect is the Health Market Inquiry, established by the Competition Commission and chaired by former Chief Justice Sandile Ngcobo. It recently released a provisional report recommending more regulation of private healthcare. It has invited comment on its ideas.

It is absolutely inevitable that whatever proposals it comes up with will be attacked as an assault on the free market in health care. This will ignore the reality – that there is no market in healthcare in South Africa, at least not one which works in the way in which markets are meant to work.

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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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