3 minute read
medical scheme members?
What does the reset button do FOr MEdiCAl SCHEME MEMBErS?
By josua joubert CEO AND PRINCIPAL OFFICER OF COMPCARE MEDICAL SCHEME
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To be 'in survival mode' is no way to live. Yet looking back over the past 18 months and longer, our industry has perhaps become settled into a reactive state. Yes, we are all part of a system that is not without challenges. Healthcare costs that escalate beyond the rate of inflation, for example, can be a bitter pill to swallow. The implementation of NHI and the role we, the private sector, will play remains somewhat of a question mark. And dare I even mention the ongoing pandemic?
But it is our own proactive behaviour that will determine our survival and it is not safe to assume that South Africans will be able to purchase private healthcare indefinitely. A total reset is already upon us with dramatic changes not only in the expectations of consumers, but also their experiences. A total reset is already upon us with dramatic changes not only in the expectations of consumers, but also their experiences. Members are stressed, they are taking strain – medical schemes need to be prepared. We need to be ready to show up.
BACK tO thE dRAWIng BOARd
So what is the ideal offering, the one that is not only attractive but also sustainable? Going back to the drawing board means reassessing what matters most. In the medical schemes context, value equates to meaningful benefits that wherever possible provide support without requiring members to dip into their own pockets.
Realistically, so many healthcare consumers avoid getting the care they need because of the financial implications. Take mental health, for example. We know that this is one of the most underfunded areas in global healthcare and the average medical scheme in South Africa has poor psychosocial benefits. This simply cannot continue.
MEntAl hEAlth MAttERS
Before COVID-19 the South African Depression and Anxiety Group (SADAG) reported taking around 600 calls for help per day. By September this year that number had increased sharply to 2 200 calls daily.
equally alarming are figures released by UNICEF in its 2021 report on the mental health of children, adolescents and their caregivers. The report cites a survey, which found that one out of
Josua Joubert
Chief Executive and Principal Officer of CompCare Medical Scheme
every five people aged 15-24 years expressed regular feelings of depression.
Whether purchasing medical scheme membership as a family or as an individual, tangible mental health benefits, such as unlimited access to a 24/7 professional helpline with referrals for one-on-one counselling when required, should not be restricted to certain options only.
This is the kind of benefit that all members on a scheme should be able to benefit from. Taking things one step further: applying a child rate on all options until the age of 27 for students and those who are financially dependent can provide a muchneeded lifeline.
dElAYEd CARE
Also under consideration is the impending wave of devastating late diagnoses that will likely be the result of so many people having delayed preventative check-ups, in an effort both to avoid the doctor’s office during COVID and reduce expenses.
An unlimited oncology programme is essential but simply not enough – it is the scheme that pays for preventative checks from risk rather than dayto-day benefits that is giving members real support in the here and now.
fAMIlY BEnEfItS
So many members’ worlds have been turned upside down with working from home, attending classes via Zoom and generally having to find a way to reset their lifestyles.
Active support in regaining and maintaining physical health with access to a fitness and nutritional programme, as well as access to a biokineticist and registered dietitian, can go a long way in helping the stressed and strained individual to restore balance.
Child benefits that include an additional emergency room visit and unlimited GP visits for those under the age of six with the option of an occupational therapy assessment, exercise prescription programme and healthy eating plan can provide just the boost that a tired young family needs.
fInAnCIAl StABIlItY
And of course, the money matters. Yes, one can choose to implement contribution increases gradually or to defer them to later in the cycle. Kicking the can down the road is a strategy. The question is whether it’s the right one for the medical scheme member.
Ultimately, it is first and foremost the job of the medical scheme to ensure that all members have access to the care they need whenever they may need it. Members are stressed, they are taking strain – medical schemes need to be prepared. We need to be ready to show up.