MEDICAL COVER
PICTURE: 123RF.COM/ DMITRII MUSKU
SPECIAL FEATURE
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Covid-19 emphasises the need for affordable health care COMPLIED BY: LYNETTE DICEY
he growing cost of private statutory obligation of the Council for Medical medical aid has long been in the Schemes to protect the interests of medical spotlight, with medical insurance schemes and their members. — or medical scheme “Ultimately, medical schemes are not-forcontributions — accounting for profit entities, owned by their members,” says the single biggest item in the Damian McHugh, executive head of consumer price index, taking up Marketing at Momentum Health Solutions. 7.6% of total household spending. “As such, their reserves are owned by As a result of constrained members, not the scheme.” household income in 2020, All medical schemes are required to Deloitte estimated that medical provide certain prescribed minimum benefits scheme membership in SA would (PMBs). In order to cover these PMBs, he fall by 8.6%. However, this was not the case explains, the base price of a medical scheme for the majority of medical schemes, with plan is largely fixed, which has made it most reporting significantly lower difficult for the medical funding industry to membership losses than expected as provide products under the Medical Schemes members prioritised their Act for the low-income market. medical scheme membership in As a result, some administrators, the midst of a global health including Momentum Health pandemic. Rather than Solutions, have launched health cancelling medical scheme insurance products that operate cover many schemes reported outside of the ambit of the that members chose to Medical Schemes Act and which downgrade to more affordable provide more affordable and plans instead. accessible cover. Demand for In SA around one in six these products, reveals McHugh, people are covered by medical exceeds demand for traditional Ultimately, schemes. The balance of the medical scheme cover. medical schemes population relies on the public McHugh supports initiatives are owned by their sector for the provision of health to improve the standard of care. members care. The government has been “The private health-care sector pursuing the idea of national reduces reliance on the state, DAMIAN MCHUGH health insurance (NHI) in order which should be considered a Momentum Health Solutions to provide universal health cover positive. The debate should not for all South Africans. In a be NHI or a public and private constrained economy and amid growing sector — there is space for both,” he insists. unemployment, the biggest challenge is how “The vaccine rollout — while not perfect — has NHI will be funded. been a good example of the public and private The president of the Health Professions health-care sectors successfully working Council of SA (HPCSA), Simon Nemutandani, together for the benefit of the country. The recently called for the reserves of medical private sector is not making money out of schemes and all other assets under the dispensing vaccines but has come together as control of medical schemes to be transferred part of a collective effort to get the country to the NHI, saying that NHI should replace all vaccinated as quickly as possible.” funding mechanisms for health. Medical Momentum Metropolitan was the first scheme reserves are estimated to be more insurer to open up multiple vaccination sites. than R90bn. At full capacity — and as vaccine stocks allow Medical schemes have strongly opposed — the company will be able to administer this proposal, pointing out that this move 20,000 vaccinations a day, reports McHugh. would be illegal and unethical. Not only is the The Covid-19 pandemic has highlighted HPCSA’s proposal in direct conflict with the inequality in the health-care space and the Medical Schemes Act but it is contrary to the stark divisions between the country’s public 17
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and private health-care sectors. Not need for more accessible health care. discounting the tremendous toll on human “More than a year down the line the lives, the pandemic has, however, provided product has been well received by local some opportunity for a positive change in the companies. One of the first companies to health-care funding environment. According introduce the benefit into its workplace was to Dr Reinder Nauta, executive chair of fast-food chain Hungry Lion, which signed up National HealthCare Group, a health-care approximately 3,000 staff members who provider in the low-cost and emerging previously relied solely on government segments of the health-care market, the health-care services.” ground has been prepared for the National HealthCare Group is not the only introduction of several fundamental private health-care provider looking to expand sector initiatives aimed at providing costaccess to quality healthcare. Netcare has efficient healthcare services to a far larger announced plans to launch additional new spectrum of the population. cost-effective products under its NetcarePlus “The health-care market has never been brand. Last year the company launched better placed for the introduction of new affordable GP consultation vouchers. The health-care models that product offers a choice between comprise a blend of firstthree types of pre-paid vouchers world health-care delivery that are redeemable for a and systems appropriate for consultation with a GP. Vouchers SA,” says Nauta, adding that either give access to an in-person newer entrants to the market consultation (R350), a are proving themselves to be consultation and prescribed more agile and innovative and acute medications (R430) or therefore better positioned to access to a virtual doctor harness the many new consultation (R250). opportunities that have This year the company This highlights the opened up for well-balanced, announced the launch of urgency of closing more affordable health-care NetcarePlus Accident and the affordability products. Trauma Cover in partnership gap In 2020, National with Hollard. The product HealthCare Group introduced guarantees stabilisation at the TESHLIN AKALOO MediClub Connect, an scene of the accident or trauma Netcare Innovative Products innovative service using event and Netcare 911 mobile communications and transportation to a contracted chat commerce technology, focused on private hospital. It also includes access to bringing the benefits of private medical unlimited in-hospital treatment for up to 90 services to the low-cost segment of the days for accident- and trauma-related health-care market. The product medical care. A Prepaid Procedures product, differentiates itself through the delivery of on the other hand, is an affordable solution health care using a mobile phone and for certain medical procedures. WhatsApp prompts to pinpoint potential “The Covid-19 pandemic has highlighted health-care issues. the urgency of closing the affordability gap Patrick Lubbe, CEO of National HealthCare through creative models that work for SA’s Group, explains that members are provided economically active population,” explains with online interactive access to doctors and Teshlin Akaloo, MD of Netcare’s Innovative nurses on WhatsApp, physical consultations Products division. “By making new funding with doctors on referral and prescribed mechanisms available to provide financial medication along with other key services for certainty around private health-care costs it R95 per employee per month. Launched at will be possible for more South Africans to the height of the Covid-19 pandemic in 2020, benefit from quality health care in the private Lubbe says the tech-savvy solution fulfils a health-care setting.”
13•06•2021
Sunday Times
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PICTURE: 123RF.COM/ALEKSANDR VELICHKO
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LEADING-EDGE MEDICAL CONSULTATION TECHNOLOGY A multi-sided virtual consultation platform called uConsult is making private home-based care singularly accessible in SA
ccording to Dr Johan Pretorius, CEO of Universal Healthcare, the fully integrated system allows patients to connect with general practitioners, no matter whether they have medical aid cover or not, or which medical scheme they belong to. Users connect from their web browsers, so there’s no need to download a restrictive medical schemeprescribed app that is only available to select groups. Unlike other virtual consultation platforms, uConsult connects patients with health-care providers using safe, scalable microservices technology, making it accessible any time from any device, be it a smartphone, tablet, laptop or desktop. “Real accessibility to quality health care is uConsult’s ultimate objective,” says Pretorius. The platform enables patients to video-chat and screen-share with their provider, and to receive encrypted prescriptions, pathology forms, radiology forms and specialist referral letters electronically. In many cases the user is able to experience the full journey from consultation to having their medication delivered without ever leaving the comfort and safety of their home or office. Users are able to search for general practitioners on uConsult by name or geolocation, and virtual consultations can take place no matter where the patient is based — locally or internationally. Providers from other medical disciplines will soon be joining the platform as well. “Patient and health-care provider
It’s the beginning of a new era for the management of our health DR JOHAN PRETORIUS CEO OF Universal Healthcare
are also able to connect with other practitioners without having to switch between systems — a revolutionary development,” says Pretorius, adding that the health-care provider does not need to have any specific software installed to enable the uConsult functionality. “The vision for this leading-edge technology is rooted in the firm belief that anyone, anywhere, should be able to access the best-quality health care available,” he says. The technology was designed and developed at the Universal office in Silicon Valley, California, and was built from the ground up by Universal’s international team. “The advent of Covid-19 has changed the face of health care and how we communicate. It’s the beginning of a new era for the management of our health and how we interact with our health-care professionals going forward. For us, this comes down to innovating and creating solutions that ultimately hinge on so much more than convenience — it’s about making inroads into inclusivity, sustainability and connectivity for health-care consumers, within and beyond our borders,” says Pretorius. 18
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Sunday Times
TIPS FOR CHOOSING THE RIGHT MEDICAL AID 7
It’s a tricky landscape to navigate, so it’s best to compare all the options to find a scheme that works for you and your family — and is within your budget
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Benefits vary from plan to plan, so establish what is and isn’t covered. “Ask what additional risk benefits might be available to you that can potentially save significant day-today expenses,” says Callakoppen. “These could include preventative-care benefits, ranging from basic screenings (such as blood pressure, cholesterol and blood sugar) through to mammograms, pap smears and prostate testing. In some cases, this extends to maternity programmes, dental checkups, flu vaccinations and more. Once you understand what is on offer, you can make an informed comparison and decision.”
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Establish what managed-care programmes are on offer. Managed-care options help members manage severe chronic conditions such as cancer, diabetes and HIV/Aids.
Age will impact on your decision. As parents of young children, ensure the option you select provides sufficient childillness benefits. For young couples looking to start a family, check that your option provides sufficient cover for maternity benefits. If you are slightly older, ensure your option covers chronic conditions and provides sufficient inhospital cover in the event of hospitalisation.
8 PICTURE: 123RF.COM/PETOVARGA
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“The first step,”says Lee Callakoppen, principal officer at Bonitas Medical Fund, “is to analyse your health-care needs”. No two people or families are alike and each will have their own health-care priorities. Do a quick personal health-care needs analysis to determine what cover you need. Factor in dependants’ needs too. Consider how often you and your family visit a doctor or specialist; over-the-counter medication or chronic medication required; chronic conditions such as high blood pressure or diabetes; specific conditions such as cancer, HIV/Aids or renal failure; and how much you spend on dentistry or optometry. Then consider which of the expenses listed above were one-off and won’t come up again soon (such as childbirth) and which are likely to come up again and again (such as flu). This will help you decide whether you need a comprehensive medical aid or a hospital plan.
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“You need to consider the savings and day-to-day benefits offered”, says Callakoppen. These benefits cover out-ofhospital expenses such as GP consultations and over-the-counter medicines. Some also cover dentistry and optometry.
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Look at what the scheme suggests to make your benefits last, bearing in mind that some plans require you to use a specific GP, hospital network and have a list of designated service providers (DSPs). These keep costs down because the scheme will have negotiated special rates with these
Consider all the costs involved before you make your final decision, such as monthly contributions — the rule of thumb is that contributions should not exceed 10% of your monthly income at an individual or household level — and the cost of copayments for various benefits claimed. A copayment is a fee that the member is liable for when making use of certain medical services. These co-payments usually apply to specialist or elective medical procedures. This differs from one medical aid scheme to another. It is one of the reasons you should always do thorough research before deciding which medical aid scheme is the best option for you. The ideal option would, of course, be the one that does not require many or any copayments from the member.
service providers. Check the network in your area before making a final decision. Also bear in mind whether you must be referred to a specialist by your GP, and whether your medical aid offers additional GP consultations, which they will pay for, after you have exhausted your day-to-day benefits.
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Lastly, consider using a broker. “Using a broker does not cost you anything. An independent broker will help you work your way through the different options and help choose the medical aid plan best suited to you and your family’s needs,” Callakoppen says. — Lynette Dicey
Technology and virtual care are being embraced by medical schemes and members. Check what is offered on the plan you’re considering and whether you’re able to access your benefits and medical information 24/7.
Consider waiting periods and exclusions. The Medical Schemes Act and the specific scheme’s rules determine this. “We recommend that you enquire with the relevant scheme about their exclusion list and waiting periods,” advises Callakoppen.
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13•06•2021
Sunday Times
MEDICAL SCHEMES MORE NECESSARY THAN EVER
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The rollout of the Covid-19 vaccine is proving the benefit of having a strong and effective private health-care sector alongside the public sector
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edical schemes came under fire from the Health Professions Council of SA (HPCSA) when its president, professor Simon Nemutandani, told parliament in May that private medical aid schemes should only be allowed to exist in SA if they are funded separately over and above tax paid for the National Health Insurance. He called for the Medical Schemes Act to be amended to ensure it aligns with the NHI. Principal Officer at Medshield Medical Scheme Thoneshan Naidoo explains that medical schemes are not-for-profit organisations which exist for the benefit of their members. The monthly contributions paid by members are pooled into a trust fund that is used to pay for the health-care claims of members according to the scheme rules and their choice of plan. Any surplus funds are transferred to the scheme’s reserves for “rainy days or health-care pandemics”. Medical schemes operate in a highly regulated environment, which, he says, is a positive for members as it provides peace of
mind knowing that their funds are safeguarded. The Covid-19 pandemic, says Naidoo, has been a perfect illustration of just how important membership of a medical scheme is. “In 2020 our top 10 claiming patients collectively cost Medshield R29m in health-care claims. The highest claim was from a 56-year-old member with major complications as a result of Covid-19. As a prescribed minimum benefit (PMB) all costs associated with a Covid-19 diagnosis are covered by the scheme’s plans.” The member was covered by Medshield’s MediValue plan, which costs just over R2,000 a month, says Naidoo, revealing that the scheme covered the member’s claims, which amounted to R7.4m. “At his current monthly premium it would have taken this member 300 years to pay this amount back. Ultimately, this is the real value of a medical scheme because by pooling all the contributions of members the scheme is able to afford claims of this size. The reality is
that very few people have this much money available to pay for a catastrophic healthcare event.” In SA medical aid premiums are considered an even bigger grudge expense than car insurance. But as Naidoo points out, if you’re in a car accident you can replace your car. A life is not replaceable, which is why access to quality health care should be a priority. South Africans have the benefit of a world-class private medical sector. “In my view it is a national treasure and, as such, should be protected and nurtured.” Public and private health care can successfully co-exist, as they have done in the UK and Australia, he says. That being said, there is no question that SA should be finding ways to supercharge
The entire country will prosper with a healthier population THONESHAN NAIDOO Medshield Medical Scheme
When was the last time you had total peace of mind?
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At Medshield Medical Scheme we believe that quality healthcare should be accessible to all. Our 8 highly affordable benefit options allow members to receive fast and focussed care. In partnership with healthcare professionals, we prevent, diagnose and treat illness so that our members can live assured.
Move to the medical scheme that fits your journey and visit momentummedicalscheme.co.za SIGN UP member@medshield.co.za 086 000 2120 www.medshield.co.za
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NHI given that it will benefit the country as a whole, says Naidoo. “Health care has a close correlation to productivity and a country’s GDP. The entire country will prosper with a healthier population.” The current Covid-19 vaccine rollout, he says, has been a good example of the public and private sectors successfully working together. “Certainly, we are further ahead in terms of the vaccine rollout than if government had done it alone,” says Naidoo. Medshield is fully supportive of the vaccine rollout programme, reveals Naidoo. “Covid-19 can be a terrible disease for some and vaccinations are the only way we’re going to curb its spread. The cost of a diagnosis for a Covid-19 test is R850 — for which medical schemes cover the expense. The cost for the double dose of the Pfizer vaccination is R870 including the administration costs. The bottom line is that the financial cost of the vaccine is insignificant when compared to the physical, emotional, social and economic toll of Covid-19, so it’s imperative that we get as many people vaccinated as quickly as possible.”
13•06•2021
Sunday Times
GOOD UPTAKE OF VACCINES
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hase 2 of SA’s vaccination rollout programme is now well under way. Though some registered sites reported a slow start in the first few days of the programme in May, there has since been a definite upswing. Dis-Chem launched and piloted a mass vaccine site at its Midrand head office in mid-May and, based on these learnings, ramped up to five vaccination sites a week later. Three new vaccination sites were opened in June, including two in the Western Cape and one in the Eastern Cape. Another two sites are ready to be opened in KwaZulu-Natal but remain subject to the
PICTURE: 123RF.COM/ALINA KVARATSKHELIA
Every week large pharmacy chains ramp up the number and efficacy of Covid-19 vaccination sites — and they have no trouble finding takers
availability of vaccine stock. Dis-Chem’s vaccination sites are not situated in its pharmacies but are in malls with clear posters and signage. The capacity to vaccinate at each site is dependent on the regular supply of vaccines, which is controlled solely by the national department of health. Ivan Saltzman, CEO of Dis-Chem, says, “We want to get jabs in the arms of as many people as possible. As such, we encourage each and every eligible South African over the age of 60 who has not yet registered on the government’s Electronic Vaccination Data System to do so.” By Friday
May 28, Dis-Chem had administered over target of administering 50 vaccinations a 25,224 vaccines across six sites. day, per site, is manageable and that an Reporting a similarly slow start initially, additional 240 vaccination sites will be Clicks says its vaccination sites going live in the next two to three We want to get have since experienced good weeks with about 40 to 50 new jabs in the arms of sites going online each week, uptake. “The rollout is going exceptionally well,” reports as many people as depending on demand and vaccine managing executive at Clicks, availability. Stores situated in areas possible Vikash Singh. “We’ve had a which don’t have easy access to phenomenal response from the other vaccination sites will be IVAN SALTZMAN public with a high attendance prioritised in the rollout. Clicks’ CEO of Dis-Chem and very few no-shows.” objective is to ultimately have 602 By June 3 Clicks had administered more registered vaccination sites, by which stage it than 15,000 vaccines at is 60 retail pharmacy will have capacity to vaccinate 30,100 per registered vaccination sites. Singh says the day, six days a week.
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Sunday Times
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