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Offline Worth-It

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Re: Medical Aid Advice
« Reply #60 on: April 17, 2018, 08:11:25 pm »
Dear Member,

As you are aware, The Minister of Finance announced a Valued Added Tax (VAT) rate increase for the first time in many years in his recent budget speech. As of 1 April 2018, the effective VAT rate will rise from 14% to 15% on most goods and services. Your Medical Aid and Gap Cover Premiums are directly impacted by this change.

However, GOOD NEWS from some schemes like Discovery, Bestmed and Bonitas, is that they are absorbing the increase for the rest of 2018 and no change will be made to their premiums.

Schemes and Gap covers communicated the news to their members, so you would have received information from your service provider.

Please do not hesitate to contact me should you have any questions in this regard


LIESL DU PLESSIS
MEDICAL AID SPECIALIST
0829240841
Liesl.cmac@telkomsa.net
« Last Edit: April 17, 2018, 08:15:33 pm by Worth-It »
 

Offline Worth-It

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Re: Medical Aid Advice
« Reply #61 on: April 17, 2018, 08:17:34 pm »
I manage and solve your daily Medical Aid Frustrations.
« Last Edit: April 17, 2018, 08:18:21 pm by Worth-It »
 

Offline Worth-It

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Re: Medical Aid Advice
« Reply #62 on: May 23, 2018, 01:20:44 pm »
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« Last Edit: May 23, 2018, 01:54:43 pm by Worth-It »
 

Offline Worth-It

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Re: Medical Aid Advice
« Reply #63 on: July 09, 2018, 06:06:53 am »
COMMENTS ON NATIONAL HEALTH INSURANCE - BY BONITAS MEDICAL SCHEME
 
While in principle we support the actions of the Government and applaud them for taking proactive measures to improve the quality of national healthcare in South Africa, we have reservations and concerns around some of the proposed amendments. And this not only in respect of representing private medical schemes. The universal National Health Insurance Bill proposed by The Minister of Health, Dr Aaron Motsoaledi, is defined by the World Health Organisation (WHO) as ‘universal health coverage means people will receive the health services they need without ‘suffering financial hardship’.

CONCERNS

No one is disputing that a comprehensive and viable healthcare system is needed in South Africa and is long overdue. However there are a number of questions which still need to be addressed and answered. Such as: How the system will ensure quality healthcare is provided; how it will be administered and how it will be funded? Another major concern is around the proposal that there be a single public purchaser and financier of health services for the country. Previous pronouncements on NHI intimated that medical schemes would essentially be reduced to playing a complementary role within the NHI dispensation. In the draft Bill, there are no explicit provisions that there will be any significant changes in the role, structure and functioning of the medical scheme industry, other than to mention that they will cover what the NHI does not cover. However, it is important to note that the NHI Bill was published in tandem with the Medical Schemes Amendment Bill which contains some fundamental changes for schemes which have potentially far reaching implications on the benefits options structuring, membership coverage and funding obligations.
 
FUNDING
Our knowledge and experience enable us to assist the government with the funding aspect, ensuring there is value for money, for instance, by avoiding duplication. We have a great deal of experience in keeping healthcare systems cost-efficient. We feel that perhaps the Bills were presented prematurely, are more of a strategy with the implementation being at best, vague.
 
MEDICAL AID COMPLIMENTARY ROLE
That said, we remain positive that we can play a role in plugging the gap left by the NHI, a gap conceded by the Government. The Bonitas mandate is to provide affordable and quality healthcare for all South Africans and we see our role as a complementary health product provider to the NHI.
 
FRAUD, WASTE AND ABUSE (FWA)
One of the major drivers of healthcare inflation and increased costs is fraud, waste and abuse (FWA) which adds an estimated R22 billion to the annual cost of private healthcare. A conservative estimate is that between 10 and 15% of claims contain elements of fraud. Private medical schemes have invested heavily to introduce robust analytical software programme to help identify anomalies and irregularities to put a stop to FWA. We’re not sure that one central fund for all healthcare funding and purchasing power is the most prudent option. A system of this kind is open to corruption and abuse on an even larger scale.
 
OPTICAL CARE
While comprehensive in terms of healthcare coverage, the NHI won’t cover everything. Dentistry, optical care and other lifestyle conditions aren’t necessarily high priorities because there are bigger burdens in other areas. According to WHO, 246-million people worldwide have low vision, and 39-million are blind – most of them in developing countries. As much as "80% of all visual impairment can be prevented or cured", says the WHO, but many do not get the treatment needed.
 
So of the world’s 39 million blind people – most of whom are in the developing world – 30 million lost their sight unnecessarily; their blindness could have been prevented through basic health care and simple procedures like cataract operations. In addition to this, 2.5 billion people don’t have access to glasses 700 years after they were invented. We believe this is one of the areas in which we could provide a complementary service.
 
MANAGED CARE
We are also keen to play an active role in preventative and managed healthcare something which has been neglected. Dr Motsoaledi has said numerous times that ‘Lifestyles diseases have become an epidemic in South Africa and this too needs to be addressed’. There are risks involved when people are only diagnosed once they suffer from a certain preventable condition. Diabetes is a good example. Many people are pre-diabetic. Through our managed care programme we encourage people to change their lifestyle and make sure they go to the doctor regularly to prevent them from becoming full-fledged diabetics. The government has made a pledge to tackle the epidemic of lifestyle conditions but we feel that the burden of disease is so vast that the NHI system will not be able to manage this for over 55 million people.
 
ABOLISHING BROKERS
We feel the role of brokers is not completely understood. Their role is not to simply to sign up members. Brokers help alleviate some of this confusion by providing an independent evaluation of a person's specific circumstances, both from a financial and healthcare perspective. From a servicing perspective, brokers are ‘invaluable’, as they aid consumers in resolving their queries quickly and efficiently, and help educate them. We feel South Africans should have a choice whether they would like to use a broker when it comes to making their healthcare choices.
 
CO-PAYMENTS
The reason why rates are higher than those prescribed by the National Health Reference Price List (NHRPL) is that the last time the rates for healthcare services were set was in 2006 – 12 years ago. With an increase of around 3-6% the prices have not kept up with healthcare inflation, the rates are not viable for a healthcare provider to run a viable practice. In fact, the rates set by the NHRPL haven’t broken the R300 mark for a consultation yet. This is why most rates are higher why there are co-payments. The reality is that many medical scheme plans offer payment way over the medical aid rate. 
 
The abolishment of co-payments is quite idealistic. This amendment would mean the full cost of healthcare would be covered by schemes. Co-payments were initially introduced to contain and manage rising healthcare costs by encouraging members to use Designated Services Providers (DSPs) and network hospitals and to manage expensive elective surgical procedures. In all instances in which co-payments arise, consumers have alternative options to take. The reality is that healthcare inflation is rising at an alarming rate and comfortably outpacing general inflation. In order to mitigate the effect of this, medical schemes negotiate rates with DSPs to ensure members access care of high quality and get maximum value for money. However, a member is still free to utilise another provider but this may attract a co-payment as this is a means we use to not only encourage a member to make better healthcare decisions. By way of example, co-payments often apply to elective procedures, or out-of-pocket payments for medicine if generics are available, and if a consumer receives healthcare from a service provider which has not been designated in terms of the rules of the scheme.
 
SOLVENCY RATIOS AND RESERVES
It has been indicated that the Council for Medical Schemes is currently reviewing the legislated 25% reserves requirement with a view to introducing a more risk-based capital approach that could allow a portion of the existing reserves to be released to help alleviate members’ needs in terms of funding for health care services and/or reduce annual premium increases. This review is welcome by the industry, should it be implemented responsibly.
 
REGULATIONS OF PRICES
There are large-scale changes that would affect private providers of care (both healthcare professionals and hospitals), including the data requirements, contracting and tariff regulations. It is envisaged that this will be the cause of much engagement and/or legal proceedings. There are some potential positives in the proposals for the introduction of some uniform prices for health services. This provision could be beneficial for the medical scheme industry as it will create a uniform set of prices/tariffs by which schemes can purchase services from providers and suppliers of health products – nonetheless, it is unclear in the Bill whether the prices that will be determined by the NHIF will be uniformly applicable to all purchasers of health care services.
 
We wish to re-iterate that the process is that comments will be received from various stakeholders within the industry over 3 months and that these will be considered before a final Bill is tabled.

Kind regards
Bonitas Medical Fund

« Last Edit: July 09, 2018, 06:09:25 am by Worth-It »
 

Offline Worth-It

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Re: Medical Aid Advice
« Reply #64 on: July 09, 2018, 06:16:13 am »
20 BESTE HOSPITALE IN SA - VOLGENS DICOVERY HEALTH

Hier is die 20 beste hospitale in SA

Die resultate van die nuutste peiling onder pasiënte wat Discovery Health uitgevoer het om die beste hospitale in die land aan te wys, toon sewe hospitale wat al vier jaar agtereenvolgens op die lysie is.

Lede van mediese skemas wat deur Discovery Health geadministreer word, het aan die peiling deelgeneem oor die hospitale waar hulle in 2017 opgeneem is. Die lys is uit 140 hospitale saamgestel.

Life Healthcare, en die onafhanklike netwerk van hospitale wat lede van die National Hospital Network (NHN) is, het die meeste hospitale op die lys.

Netcare het net een hospitaal op die lys.

NHN het die meeste hospitale wat reeds vier jaar agtereenvolgens op die lys is.

Hier is die lys van die 20 beste hospitale in alfabetiese volgorde:

1. Ahmed Al-Kadi- private hospitaal (Durban, KwaZulu-Natal)
2. eThekwini-hospitaal en -hartsentrum (Durban, KwaZulu-Natal)
3. Gateway- private hospitaal (Umhlanga Rocks, KwaZulu-Natal)
4. Hillcrest- private hospitaal (Durban, KwaZulu-Natal)
5. Life Bay View- private hospitaal (Mosselbaai, Wes-Kaap)
6. Life Carstenhof-hospitaal (Johannesburg, Gauteng)
7. Life Chatsmed Garden-hospitaal (Durban, KwaZulu-Natal)
8. Life Mount Edgecombe-hospitaal (Durban, KwaZulu-Natal)
9. Life Roseacres-hospitaal (Johannesburg, Gauteng)
10. Life St. Dominics-hospitaal (Oos Londen, Oos-Kaap)
11. Life Suikerbosrand-hospitaal (Heidelberg, Gauteng)
12. Life West Coast-hospitaal (Vredenburg, Wes-Kaap)
13. Lowveld-hospitaal (Nelspruit, Mpumalanga)
14. Mediclinic Milnerton (Kaapstad, Wes-Kaap)
15. Mediclinic Panorama (Kaapstad, Wes-Kaap)
16. Mediclinic Victoria (Tongaat, KwaZulu-Natal)
17. Netcare N1 City-hospitaal (Kaapstad, Wes-Kaap)
18. Nu-Shifa-hospitaal (Durban, KwaZulu-Natal)
19. Wilmed Park- private hospitaal (Klerksdorp, Noordwes)
20. Zuid-Afrikaans-hospitaal (Pretoria, Gauteng).

Vier jaar op die lys

Hier is die lys wat Netwerk24 opgestel het van die hospitale wat al vier jaar op die lys is sedert die peiling deur Discovery Health begin is:
1. eThekwini-hospitaal en -hartsentrum (Durban)
2. Hillcrest- private hospitaal (Durban)
3. Lowveld-hospitaal (Nelspruit)
4. Mediclinic Milnerton (Kaapstad)
5. Mediclinic Panorama (Kaapstad)
6. Wilmed Park- private hospitaal (Klerksdorp)
7. Zuid-Afrikaans-hospitaal (Pretoria)

Die twee hospitale wat verlede jaar drie jaar agtereenvolgens op die lys was en nou uitgeval het, is die Mediclinic Stellenbosch en die Midvaal- private hospitaal (Vereeniging, Gauteng).

Dié wat nou die derde jaar agtereenvolgens op die lys is, is die Gateway- private hospitaal en Life Bay View- private hospitaal. Die Netcare N1 City-hospitaal is die tweede jaar agtereenvolgens op die lys.

Discovery sê die inligting van die peiling word openbaar gemaak om die bestuur van hospitale aan te moedig om hul pasiënte se sienings ernstig op te neem.

Discovery

Volgens dr. Roshini Moodley Naidoo, hoof van die gehalte van sorg by Discovery Health, help dit om die pasiënte se ervaring van die sorg wat hulle in hospitale ontvang, openbaar te maak. Dit is nie net om erkenning aan uitnemendheid te gee nie, maar ook geleenthede te skep om gapings aan te pak.

Die peiling word aan volwasse lede van die mediese skemas gestuur wat deur Discovery Health geadministreer word, sewe dae nadat hulle uit die hospitaal ontslaan is. Lede wat meer as een keer in dieselfde hospitaal opgeneem is, kan net een keer elke vier maande aan die peiling deelneem. As dieselfde lid na ’n ander hospitaal gaan, word ’n peiling ook gedoen.

Van die vrae hou verband met die gehalte van die sorg wat die verpleegpersoneel bied; die reaksietyd van personeel; die gehalte van dokters se sorg; die hospitaalomgewing; pynbestuur; inligting wat aan die pasiënte gegee word oor hul medikasie; inligting wat aan die pasiënte gegee word oor hul ontslag uit die hospitaal, en ’n algehele telling.

Moodley Naidoo sê daar is in sekere kategorieë die afgelope jare voortdurende vordering gesien. Dit kategorieë wat deurlopend die hoogste punte kry, is kommunikasie deur dokters en pynbestuur. Volgens haar is ’n goeie verbetering gesien in die inligting wat oor medikasie gegee word, en in die kommunikasie deur verpleegpersoneel.

Waar daar ’n verbetering nodig is, is met die ontslag van pasiënte. “Pasiënte wat goed voorbereid is op hul ontslag uit die hospitaal, het ’n beter kans om gesond te bly en sal minder waarskynlik weer opgeneem word.

“Herhaaldelike opnames word wêreldwyd beskou as ’n tekortkoming in gesondheidsorg.”
 

Offline Worth-It

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Re: Medical Aid Advice
« Reply #65 on: July 09, 2018, 06:27:26 am »
COMMENTS ON NATIONAL HEALTH BILL - BY ZEST LIFE GAP COVER

As a Gap Cover provider we would like to comment on Health Minister Aaron Motsoaledi's public address on the NHI Bill and the Medical Scheme Amendment Bill.

We are fully supportive of the NHI Bill and the goal of providing universal healthcare for all South Africans. This we believe to be consistent with our constitution and supports the enshrined rights contained therein. Despite the mammoth task of realising this vision and considerable resource and implementation challenges that will need to be overcome, we see this as a massive step in the right direction.

The Medical Schemes Amendment Bill which seeks to eradicate medical scheme co-payments, does not serve the interests of all South Africans and does raise some serious considerations around the practicality of implementation.

Before addressing the shortcomings of the Medical Schemes Amendment Bill, it's important to understand that a bill is a proposed law which is yet to be made law and as such it is merely a proposal by Government. A bill remains subject to public and industry comment and only when these issues have been adequately addressed through further probable amendments can a bill be finalised as an Act of Parliament. With a contentious subject such as this and the millions of South Africans that are affected by it in its current form, the process may take years to finalise.

The burning question is how the bill in its current form could obligate medical schemes to pay for the total cost of healthcare treatment for its members without resulting in a significant increase in member contributions. The concern is that medical schemes will be forced to increase member contributions to enable full cover for members. This will result in a further decline of membership.

The suggestion by the Health Minister that the abolishment of co-payments can be funded by reserves is not workable especially in the medium to long term because reserves are needed for the security of solvency and the reserves will run out. The suggestion to abolish broker commission is also not workable. This will impact on the livelihood and employment of brokers and in the complex world of medical schemes, brokers provide a vital role for the public.

The main problem the Health Minister is trying to address is the uncapped fees that specialists charge. The limited pool of South African medical specialists are in high demand and they operate using free market principles where high demand and short supply of this expertise has an inflationary effect on their service fees. Should the Health Ministry attempt to control the fees that specialists may charge, it will likely drive a mass exodus of doctors from the county which will place us in an even worse position. This will not only be totally detrimental to medical scheme members but also the recipients of NHI as the successful implementation of universal healthcare requires us to retain our existing health specialists and draw foreign trained doctors to make up the resource shortfall.

Our conclusion is that the bill is likely to take a long time before it is finalised and will probably change significantly. In the meantime Gap Cover will continue to plug the essential shortfalls not covered by medical scheme payments. We do not forsee that we will achieve a system where medical schemes cover absolutely everything and there will therefore always be a need for Gap Cover. It may transpire that medical schemes will have to pay more than they currently do. This will correct the imbalance where Gap Cover currently pays more than the medical schemes for specialist charges, but this remains to be seen. A further possible outcome is that the bill will result in the re-introduction of a universal tariff for all medical schemes, but in our opinion it is not possible to make this tariff high enough to cover the total cost of healthcare for all the members.