Sunday Times Lifestyle Medical Cover (June 11 2023)

In today s stressful world, we often overlook the importance of self-care, assuming it to be an indulgence rather than a necessity. Self-care is about individuals taking charge of their own health and wellbeing a shift in focus from sickness to wellness.

Self-care encompasses various activities, from regular exercise and a healthy diet to meditation and mindfulness practices. Anthea Towert, a certified financial planner and principal consultant at Insight Advisory Solutions, says that those who prioritise self-care improve their overall health status and wellbeing, and reduce the risk of developing lifestyle-related chronic diseases such as diabetes, high cholesterol and heart disease.

By engaging in regular physical activity and eating a healthy diet, most individuals can maintain a healthy weight, lower their blood pressure and cholesterol levels, and reduce the risk of developing obesity-related conditions, she says, adding that self-care helps people manage stress levels and reduce burnout that, if left unchecked, can lead to a range of mental health problems, including depression and anxiety.

Problems occur when we neglect self-care for too long in terms of poor diet, lack of exercise and a lack of attention to mental health. The cumulative effects are increased risks of chronic disease. By the time these diseases are diagnosed, they are much more difficult to manage and can be life-altering, she warns.

Medical aid schemes, the primary funders of private health care, are under growing pressure to find ways to manage the increased cost of health care while improving affordability and value for members. One way they are doing this is by shifting

IS THE NEW CURRENCY IN HEALTH CARE

the focus from exclusively funding treatment for sickness to including wellness to help prevent or manage chronic health conditions before they become more serious and costly to treat.

Members are increasingly seeking health-care products and solutions that promote health and wellbeing alongside the treatment of illness, says Towert. Medical aid schemes are responding to these changing needs by offering more comprehensive preventative care and self-care benefits paid from risk cover and not from members medical savings. These include annual health checks, vaccinations and immunisation, cancer screening and early detection of disease tests, wellbaby and well-child check-ups and preventative dental care, to name a few.

To help prioritise and promote a shift to this wellness culture, schemes and health insurers are supplementing preventative care and screening benefits with ancillary wellness-focused lifestyle and rewards programmes to incentivise members who take steps to improve their health through selfcare, she adds.

These programmes aim to promote healthy habits and behaviours, advancing a culture of wellness over sickness and increasing member engagement and satisfaction. Members who actively engage benefit from tangible and significant rewards, including discounts on health and wellness products, travel and entertainment, as well as shopping vouchers.

With or without a supporting wellness programme, we can all improve our health and wellbeing and positively impact our longer-term health-care costs by incorporating self-care into our daily lives, says Towert.

Members are increasingly seeking health-care products and solutions that promote health and wellbeing

As the cost of living skyrockets, medical-aid membership is another expensive item on your household budget and, if you rarely get sick, is it really worth it?

Kevin Aron, principal officer at Medshield Medical Scheme, maintains that the benefits far outweigh the cost, particularly given that there is no guarantee you will remain healthy enough to cover medical expenses out of your own pocket.

But perhaps most important, he says, the right plan means you won’t have to rely on state clinics and hospitals for care. It also means you can have tests, screenings and procedures done early without waiting to save enough to afford it, potentially worsening your condition.

“Health care does not always require hospital stays. Expenses such as physiotherapy, dental visits and costly chronic medication can occur,” he says.

The secret to affordability, says Aron, is to choose a medical-aid option that will benefit you in the long term.

“Schemes usually negotiate preferred rates with health-care providers to ensure that the member’s benefits last throughout the year, but provider networks may differ from option to option.

“Choose a plan that suits your medical and financial needs. Read and understand the benefits and networks of your selected option and discuss it with

your financial adviser,” he says.

The Medical Schemes Act provides two types of waiting periods for individuals wanting to join schemes: a general waiting period of up to three months, and a condition-specific waiting period of up to 12 months.

The waiting period, explains Aron, protects other members of the scheme by ensuring that individuals can’t make large claims shortly after joining and then cancel their membership after the claim has been settled.

“All these factors ensure you get the best

value for money,” he says.

Digital technologies are making it easier for people who can’t see a doctor or nurse in person to access care quickly, no matter where they live. Electronic health records, for example, give doctors and nurses access to much-needed information about a patient.

Aron suggests looking into digital health apps which offer a variety of resources including remote monitoring, consultation services and educational materials. There are also wearables like smartwatches and activity trackers to keep

track of vital signs and long-term conditions, giving patients and doctors feedback in real time, allowing them to adjust treatment plans remotely as needed.

Telemedicine has become essential in providing post-Covid health care, as it restores trust and offers personalised care while respecting personal needs.

Medshield’s SmartCare, for example, uses long-term partnerships with clinics and pharmacies, and Quro Medical’s Hospital-at-Home service provides safe alternatives to hospitals as the centres of patient care and management.

Patients can receive a personalised treatment plan at home instead of a general hospital ward for a specified period without compromising the quality of care.

The Quro clinical team schedules regular home visits, daily or more frequently, to deliver the treatment and care required,” he says, adding that other channels are also available, providing patients with access to advice and support outside home visits.

Affordability underlies all of Medshield’s nine options, offering coverage for lower- to higher-income households, says Aron.

“We pride ourselves on providing superior quality that does not break the bank,” he says, adding that for 12 consecutive years Medshield has received an AA-Global Credit rating as a testament to the scheme’s financial stability and claims-paying ability.

The secret to affordability is to choose a medical-aid option that will benefit you in the long term

Kevin Aron, Medshield Medical

Scheme

Picture: 123RF.COM/GIRAFCHICK

FLEXICARE OFFERS AFFORDABLE HEALTH CARE

The majority of South Africans can’t afford comprehensive medical cover guaranteeing them access to private health care. Discovery Health’s research reveals there are between 5to 8-million South Africans in formal employment who don’t have medical aid. Yet they already utilise the private health-care sector for their primary healthcare needs and are paying out-of-pocket for each consultation and for prescribed medication for each point of entry.

The good news is that a number of companies from retailers to insurers are offering alternative insurance solutions that provide more affordable access to private

health care. These insurance products differ from medical aid schemes, with the latter governed by regulations that require all schemes to pay for a basic level of care for 27 chronic conditions and 270 diseases. Healthcare insurance products don’t cover PMBs which allows them to be more affordable.

In February, Clicks announced that it had partnered with Discovery Health and Auto & General Insurance to offer Flexicare, an insurance product providing affordable private day-to-day health-care cover.

The Flexicare offering has been available since 2018 to corporate employers to provide affordable health-care cover for staff. Over the past five years, it has been provided to

THE ROLE OF HEALTH INSURANCE PRODUCTS

South Africa’s health-care system faces a number of challenges not least of which are limited resources, a high disease burden and significant inequalities in access to care. A twotier system means the majority is serviced by the public health-care sector while about 16% contribute to medical aid schemes and are served by the private sector. However, between 5- to 8million employed people don’t have access to medical aid.

Medical schemes are struggling to attract younger members who are deterred by the high costs. The membership profile backs this up: members are getting older which in turn makes it harder for schemes to be relevant and affordable for a younger population. The healthcare industry is working to address this by creating low-cost solutions and plans, including healthcare insurance products that cater to younger, often financially constrained South Africans.

Damian McHugh, chief marketing officer at Momentum Health Solutions, believes that although health insurance products can t adequately address all the health-care system s challenges, there is value in any solution that provides cover to the many employed citizens who do not currently enjoy health-care cover.

- Damian McHugh,

Health insurance products offer more affordable premiums, making them a viable option for many who have not previously had access to cover, alleviating some of the pressure on a highly constrained public health-care system, he says, adding that they already provide

cover to an estimated 1-million South Africans for a range of health services that may not be covered by medical schemes

However, these products are not a substitute for medical scheme membership, as they don’t offer the same level of cover and protection

“Medical schemes are governed by regulations that require them to pay for a basic level of care for 27 chronic conditions and 270 diseases. Health insurance, on the other hand, is structured around more specific offerings ” Momentum Health Solutions is the largest open insurance player. McHugh reveals that growth in the health insurance products market typically exceeds medical scheme growth by some margin, albeit off a lower base.

If health insurance products are properly regulated and designed to complement the existing health-care system, they can play an important role in improving access to health care, says McHugh.

He argues that more needs to be done to build a health-care system capable of delivering quality care to all The first critical step is updating the outdated legislation. The Medical Schemes Act was passed in 1998. It needs to be refreshed to ensure that it is meeting modern demands and addressing key challenges.

There are already pockets of excellence that illustrate how effective healthcare can enable and improve the economy, he adds. These include a growing number of companies that have invested in on-site clinics and that cover primary health-care visits, solutions which are alleviating the burden on the state.

about 100,000 employees across 450 different employer groups.

Members of Clicks’ loyalty programme, ClubCard, who purchase Flexicare earn 10% cashback on their monthly premium as a loyalty benefit, simply for paying the premium and ensuring the cover remains uninterrupted. The cashback can be used at any Clicks store countrywide.

Vikash Singh, Clicks managing executive, says the Flexicare offering is part of the retailer’s continued commitment to providing great value, convenience and rewards for customers.

“A health-insurance product, Flexicare is not intended to be a substitute for medical

scheme membership. Rather, it broadens the availability and affordability of private health care to more South Africans,” he said. Its benefits include unlimited face-to-face and online doctor consultations, medicine, dentistry, eye care, X-rays, flu vaccines, maternity, health checks, blood tests, procedures in GP rooms, HIV care and private ambulance services. There is an optional add-on benefit of trauma cover at a private hospital for an additional fee. Trauma cover provides additional private emergency health-care services for the individual and all registered beneficiaries for a range of serious events including burns, car accidents and serious head or chest injuries

If health insurance products are properly regulated they can play an important role in improving access to health care

Momentum

Picture: SURFUPVECTOR

The days are getting shorter and the nights longer which means winter is here and, with it, “flu season”

As we head into winter it’s important to take extra precautions to protect your health, says Dr Morgan Mkhatshwa, clinical executive at Bonitas Medical Fund.

The National Institute for Communicable Diseases (NCID) defines influenza or “flu” as an acute viral respiratory infection, transmitted by the influenza virus. The virus has three main types: A, B and C. The currently circulating seasonal viruses are A (H1N1), influenza A (H3N2) and influenza B viruses. These viruses are typically in circulation in the winter months in South Africa and usually begin in June.

Although the flu vaccine will not completely eliminate the risk of developing the flu, says Mkhatshwa, it will help reduce the risk of developing a severe infection and ensure a faster recovery.

“Annually, seasonal flu kills between 6,000 and 11,000 people in South Africa. Having the flu vaccine is a good precautionary measure,” he says.

He advises having the flu shot annually because viruses mutate and change, which means last year’s vaccine will not keep you safe this year. The flu vaccines for 2023 are Vaxigrip Tetra and Influvac Tetra, both available as a single-dose 0.5ml shot.

“The vaccine helps produce antibodies and boosts your immune system to fight off the virus,” he says, adding that it’s best to

vaccinate earlier rather than later to give your body a chance to build up antibodies.

Flu vaccinations are available at most pharmacies and the costs are generally covered by medical schemes.

Mkhatshwa recommends that anyone in a high-risk group should have a flu shot. This includes health-care workers; those over the age of 65; individuals with cardiovascular disease, including chronic heart disease, hypertension, stroke, diabetes, chronic renal disease and chronic

lung disease (including asthma and chronic obstructive pulmonary disease); pregnant women; and those living with HIV/Aids.

vaccine or those who are already suffering from flu symptoms should also avoid it. The vaccine is not licensed for children under the age of six months.

Contrary to popular perception, the flu shot can’t cause flu. “Vaccines are currently made either with flu vaccine viruses that have been ‘inactivated’ and are not infectious or with no flu vaccine viruses at all,” says Mkhatshwa. “However, you might experience some common side-effects from the vaccine such as soreness, redness, tenderness or swelling where the shot was given. Serious allergic reactions are rare.”

The vaccine helps produce antibodies and boosts your immune system to fight off the virus

Dr Morgan Mkhatshwa, Bonitas Medical Fund

He cautions that individuals who are allergic to eggs or egg proteins should avoid the vaccine as the manufacturing process involves the use of chicken eggs. Anybody who has had a severe reaction to a flu

Covid-19 and influenza viruses are similar in disease presentation. This is mainly because both cause respiratory disease, which presents as a wide range of illness from asymptomatic or mild through to severe disease and death. Both are transmitted by contact, droplets and any material that can carry infection. Hand hygiene and social distancing are recommended to avoid contracting flu or when you have flu.

“It’s possible to have both the Covid-19 vaccine and the flu vaccine at the same time,” says Mkhatshwa, “but one should be on the left arm and the other on the right.”

Cancer accounted for nearly 10-million deaths in 2020, according to the World Health Organisation. In South Africa, incidences have increased considerably since the beginning of the pandemic, making it a major and growing public health concern.

Analysis conducted by Sirago

Underwriting Managers reveals that initial cancer diagnosis claims volume increased by 631% in 2021 and 2022, compared to 2019 and 2020.

Conceding that the number of new diagnoses is alarming, Dr Dion Kapp, executive manager for Managed Healthcare and Providers at Bestmed Medical Scheme, says understanding the realities of the disease and its predominance is an important step towards encouraging the public to take preventive action.

“Frequent cancer screening and prevention remain the most effective methods of curbing the economic, financial, physical and mental toll the disease takes on people of all ages, ethnicities and circumstances. This includes the high costs of treatment that become necessary with latestage diagnoses,” he says.

In the past four years the oncology landscape in South Africa has shifted considerably, with the pandemic playing a central role in rising cancer cases recorded since it began. As with Sirago, Bestmed recorded a steep increase in cancer incidences in recent years. Kapp says the reason is not an increase in screening or any known direct correlation between the Covid19 virus and cancer, but the knock-on effect of Covid-19, especially during the hard lockdown when people avoided visiting

CANCER CASES PREDICTED TO RISE

all predominant types of cancer between 2020 and 2022, with breast cancer increasing by 35% and prostate cancer by 45%.

“Breast and prostate cancer remain the dominant types in South Africa. Though this is nothing new, we are seeing comparatively higher numbers for this period, indicating that many of these incidences could have been detected two years ago,” Kapp says, adding that more frequent screening tests give people a better chance of being diagnosed earlier, thus making treatment more effective.

The benefits paid by Bestmed towards oncology treatment increased by 47% in 2022. The biggest contributor of this escalation, reveals Kapp, was biological medication and immunotherapy. The cost increase for these two alone was 31%.

Radiology-related claims also increased, with advanced radiology such as MRI, CAT scans and nuclear medicine used to monitor and diagnose cancer increasing by 19% in 2022, compared to pre-pandemic levels.

Kapp attributes the biggest driver of increased cancer treatment costs to advanced-stage cancer diagnoses.

hospitals or pathologists for fear of contracting the virus.

Actuaries predict that cancer incidences will almost double in South Africa by 2030, from 62,000 cancer-related deaths in 2019 to 121,000 in seven years’ time based on existing mortality trends, with the numbers affected by an ageing and growing population. These predictions align with data collected by Bestmed which show steep increases across

“Late diagnoses often result in the prescription of more novel medicines to treat cancers more aggressively, which are more expensive. This is why it’s so important that individuals reach out to their medical aid scheme to find out which preventive screenings, such as mammograms, pap smears and prostrate exams, are available to them.”

Bestmed, he reveals, offers a number of preventive health benefits that members can access, along with various oncology care benefits depending on their selected plan.

Picture: 123RF.COM/RASTUDIO

Frequent cancer screening and prevention remain the most effective methods of curbing the toll the disease takes on people

Dr

Dion Kapp, Bestmed Medical Scheme

Government is pushing to get the National Health Insurance (NHI) Bill adopted despite objections from stakeholders, including medical schemes. Almost without exception, medical schemes say that while they are not opposed to universal health care which is the overall aim of NHI they reject the current iteration of the billas unworkable.

Critics of the bill argue the initiative is not affordable. Jeremy Yatt, principal officer at Fedhealth Medical Scheme, says the biggest issue with NHI is around management rather than funding. Given the shambolic state of public hospitals, his concerns are not unfounded. “The issue of NHI crops up every five years whenever there is an election looming,” says Yatt, maintaining that what is driving the NHI initiative is ideological rather than a practical solution to the myriad issues facing the public health sector.

“The reality is that we have a wellfunctioning private health sector, albeit expensive. The sector has offered to assist the public health sector with both resourcing and protocols but there has been no willingness from the state to address these issues. While government remains convinced that a single funder model will solve all the health-care system’s problems, without the necessary oversight and reforms it is doomed to fail,” he says.

South Africa’s medical schemes have previously been described as national assets, with the Health Professions Council president telling parliament in 2021 that the reserves and assets of medical schemes should be handed to the NHI.

Yatt insists that medical schemes are not

THE CHALLENGE IS TO ADD VALUE

national assets and their reserves are not owned by schemes but by members. Any attempt at appropriating these reserves is therefore likely to be challenged in court.

Continuing the two-tier structure, says Yatt, is arguably not the worst idea with the private sector focused on providing cover for employees and those who can afford to pay for cover and a second tier providing cover for the remainder of the population.

Conceding that affordability is an issue, Yatt says schemes do try to negotiate better prices with providers. What tends to push costs up is when members have unnecessary procedures and treatments.

“We try to encourage a more conservative approach, although it’s often hard to find the right balance.”

Helping to drive up the cost of procedures is the rising cost of medical

malpractice insurance, he adds. The annual insurance premium for an obstetrics specialist, for example, is more than R1m.

To ensure sustainability, medical schemes need to appeal to younger and healthier members to help subsidise older members. However, many young people are opting not to join medical schemes given the high costs.

“The challenge for medical schemes in this environment is to add value for members, particularly younger members. Fedhealth, for example, is working at incorporating other life-stage appropriate benefits, such as providing the contraceptive pill to members out of risk rather than savings and allowing members through our flexiFED range to build their options based on what they can afford. Each option has five price points. We’re also looking to offer personalised genetic testing to members to help them and their healthcare providers make more informed decisions and reduce their individual risks. Genetic testing could ultimately prove to be a game-changer as far as preventative health care is concerned.

The reality is that we have a well-functioning private health sector, albeit expensive

Jeremy Yatt, Fedhealth Medical Scheme

Flexicare is a health insurance product for South Africans that provides reasonably priced private day-to-day healthcare cover distributed through the Clicks retail network. It is not a medical scheme, nor is it intended to be a substitute for medical scheme membership. Flexicare has been available to Clicks employees since 2018, and for the first time ever, it is now available to our Clicks customers.

“We are pleased to partner with Discovery Health and Auto & General Insurance to make private healthcare cover easily available and affordable for everyone, with the added benefit of cashback in your pocket,” says Vikash Singh, Clicks Managing Executive. “This forms part of our continued commitment to providing great value, convenience and rewards for our customers.”

Flexicare is available to all our Clicks customers, but our ClubCard members earn the right to a unique loyalty benefit. When they choose Flexicare using a simple four-step digital purchasing process, they can earn 10% ClubCard cashback on their premium. For an average family of four, this amounts to R129.30 in monthly ClubCard cashback that can be used at any Clicks or The Body Shop nationwide.

Why Flexicare for our ClubCard members?

Discovery Health’s research demonstrates that there are five to eight million South African residents in formal employment who do not have medical aid. Yet, they already utilise the private healthcare sector for their primary healthcare needs and are paying out of pocket for each consultation and prescribed medication, for each point of entry.

Flexicare is a product of Auto & General Insurance Company Limited, administered by Discovery Health, and designed to provide access to private healthcare services from only R435 per month. The benefits include unlimited GP consultations, medicine, dentistry, eye care, x-rays, flu vaccines, maternity, health checks, blood tests, procedures in GP rooms, HIV care and private ambulance service, with an optional add-on of trauma cover at a private hospital (for an additional fee from R174). Trauma cover, underwritten by Discovery Insure, provides additional private emergency healthcare services for the individual and all registered beneficiaries for a range of serious events including burns, car accidents, and serious head or chest injuries to name a few.

only R435

Unlimited GP consultations: This includes online doctors’ consultations, with an allocated network doctor. Members are not required

with

“This partnership brings a truly innovative, integrated healthcare product to the public, and most importantly broadens availability and affordability of private healthcare to more South Africans,” says Ricardo Coetzee, Head of Auto & General.

“Our research and experience have proven the importance of creating easy-to-understand healthcare products. Having affordable cover also means ensuring that people never have to pay out of pocket or face hidden costs. Flexicare is provided through a suite of world-class digital tools so that people can manage their membership and retrieve their benefits on the go,” says Nonku Pitje, Chief Growth Officer at Discovery Health. “Flexicare reflects our commitment to expand cover to millions more South Africans, and it’s made possible by the strengths of excellent partners who share this vision. We can’t wait to make a significant impact on people’s lives through Flexicare and through our network of dedicated healthcare providers,” she added.