MEDICAL COVER
PICTURE: 123RF.COM/ DMITRII MUSKU
SPECIAL FEATURE
T
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
LifeStyle
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