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We have looked around to find the best medical insurance cover which satisfies the above criteria. It only take a few seconds to complete the inquiry form above and we will take the fuss and  hassle out of it and we will contact you.








The biggest medical aid schemes in South Africa – and how much they’re charging in 2018

The majority of South Africa’s biggest medical aid schemes have released their prices for 2018, showing below 10% increases across all plans.

According to the latest statistics released by the Council for Medical Schemes (CMS), there are currently 82 medical aid schemes operating in South Africa with a total subscription of just under 8.9 million members as at December 2016.

Discovery remains the largest medical aid scheme in the country, with over 2.7 million members.

This is followed by the Government Employees Medical Scheme (GEMS) with 1.8 million members, and the Bonitas Medical Fund, with just under 680,000 members.

Due to the nature of medical aids, and how each scheme is structured to cater for different hospital networks and cover different medical needs, it’s incredibly difficult to compare like for like, especially on price.

However, with all medical aids now releasing their contribution structures for 2018, the tables below outline the price changes among the biggest* (open) schemes for next year.

The biggest medical aid schemes in South Africa

Scheme Members
Discovery 2 707 000
GEMS 1 801 000
Bonitas 676 785
PolMed 497 130
Momentum Health 257 370
BankMed 214 305
BestMed 200 400
MediHelp 195 860
MedShield 153 415
LA-Health 147 780

For 2018, medical aids have mostly kept their rate increases within range of the medical aid industry inflation rate (inflation plus 3%), with few plans going over the 9% estimate.

Discovery’s rates have been hiked at an average of 7.9%, and Bonitas at an average of 8.7%.

Momentum Health is yet to publish its pricing for 2018, but has announced that prices for its medical aid plans will be hiked by an average of 8.3% in 2018.

In 2017, medical aids were forced to hike rates by over 10%, following a rise in medical costs and an increase in the number of fraudulent claims.

Over the past decade and half, the average year-on-year increase of medical scheme contributions has been 7.6% – almost 2 percentage points higher than CPI, on the basis of rising medical costs.


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SA gewaarsku oor dodelike longpes

Die dodelike longpes wat in Madagaskar uitgebreek het, eis al hoe meer slagoffers met die dodetal wat nou al gestyg het tot 48 – en die Suid-Afrikaanse owerhede is gewaarsku om hier gereed te wees vir enige uitbreking.

Die Wêreldgesondheidsorganisasie (WGO) sê 449 gevalle van longpes is reeds in Madagaskar bevestig.

Die WGO waarsku daar heers kommer op internasionale vlak daaroor nadat ’n Suid-Afrikaanse basketbalspeler wat ’n klubkampioenskapsreeks bygewoon het, ook aangesteek is. Die speler is in Madagaskar suksesvol behandel en het volgens die WGO na Suid-Afrika teruggekeer. Hy en sy spanmaats word gemonitor.

Daar is geen reisverbod na of van Madagaskar nie.

Die nasionale departement van gesondheid het verskeie maatreëls ingestel, soos om lugrederye te waarsku om op die uitkyk te wees vir siek mense op vlugte.

Amptenare by Suid-Afrikaanse hawens is gevra om hul prosesse op te skerp om mense wat in die land aankom, behoorlik te ondersoek.

Alle provinsiale gesondheidsamptenare is ook in kennis gestel om gereed te wees vir enige uitbreking van die plaag.

Mense wat terugkeer vanaf Madagaskar moet hul gesondheid vir 15 dae lank fyn dophou en dadelik behandeling opsoek indien hulle ’n koors ontwikkel, lyf- en kopseer kry, kortasem raak, en hul limfkliere pynlik en ontsteek is.

Elsabé Brits het vroeër berig longpes is meer dodelik as builepes. Dié pes word veroorsaak deur ’n bakterie in knaagdiere soos rotte en muise en hul vlooie.

’n Mens kry dit van die rotte of/en die vlooie wat op hulle teer.

Volgens die WGO is dit dodelik indien dit nie gou genoeg

behandel word nie. Dit is omdat dit die longe bereik en dan kan dit regstreeks van mens tot mens oorgedra word.

Suid-Afrikaanse besoekers aan Madagaskar is deur die nasionale departement van gesondheid gewaarsku om digbevolkte gebiede daar te vermy en chirurgiese gesigmaskers te dra wanneer hulle reis.

Deur: Netwerk 24


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Baba dood na swak diens in staatshospitaal – Nuwe ma ontneem van haar geluk

‘n Bronkhorstspruit ma, Priscilla Fuhri (39), is ontneem van haar geluk toe sy moes toekyk hoe haar pasgebore baba dogtertjie voor haar oë versmoor en tot sterwe kom as gevolg van nalatigheid by ’n mediese regerings instansie.

Priscilla het op Maandag, 11 September in kraam gegaan. Sy was teen die tyd net ses maande en ’n week swanger. Sy moes as gevolg van komlikasies, op vier en ’n half maande gaan vir steke in haar baarmoeder. Die rede hiervoor was dat haar baarmoeder te klein is en die steke verhoed dat die baarmoeder skeur wat ‘n vroeë kraam belemmer.

Om ongeveer 16h00 die Maandag het Priscilla abnormale voorgeboorte tekens gewys soos bloeding en vererge kraampyne. “Dit het groot kommer gewek” sê sy. Sy is deur ’n barmhartige Samaritaan na die Bronkhorstspruit Hospitaal geneem. Daar aangekom is sy op ‘n drup geplaas. Sy is toe per ambulans na ’n Staatshospitaal vervoer.

Daar aangekom is Priscilla direk ongevalle toe. “’n Paar dokters en spesialiste het by my kom inloer en een het selfs ’n sonar gedoen” vertel sy. Alles het volgens die sonar in orde gelyk. Haar steke is sonder verdowing uitgesny. Om 22h00 is sy na die geboortesaal geneem. Daar is sy op ‘n bed geplaas en klaarblyklik so gelos sonder sorg. Die volgende oggend om 01h00 het sy die klokkie gedruk nadat sy gevoel het iets is nie pluis nie. Sy het op haar hardste geskree dat iemand ’n suster moet roep omrede sy dink die kleintjie oppad is. Om 04h10 het haar water gebreek.

Priscilla het knaend die klokkie gedruk en om hulp geroep. Haar hulpkreet het op dowe ore geval. Toe Priscilla na ’n paar minute haarself kon kry om regop te sit kon sy self haar baba dogtertjie se bene gesien. Sy het weer probeer om ’n suster in die hande te kry. ’n Persoon aan diens het toe intussen opgedaag. “Die suster het vir my gesê sy sal iemand kry om my te help. Sy het my ook meegedeel dat die een suster slaap en die ander een besig is op haar foon” vertel sy terwyl die trane by haar wang afrol.

’n Pasiënt wat langs Priscilla gelê het, het opgestaan en die kleintjie met die hoek van die deurweekte, bebloede laken toegegooi. Sy het Priscilla ook geluk gewens en haar ingelig dat ’n baba dogtertjie gebore is. Vyftien minute nadat die ander suster geloop het, het ’n suster daar aangekom en gesien dat die dogtertjie, toe genoem Kylie Mckenzie Oberholtzer, nog lewe. Direk daarna het ’n suster daarna inkom en het sy aan Priscilla gesê dat haar babatjie dood gebore is.

“Op die stadium was my kleine Kylie al dood”. Snikkend vertel Priscilla verder van die gebeure. “My woorde aan die suster was dat sy dood sal wees aangesien niemand haar kom help het nie”. Die suster het toe volgens Priscilla ’n stomp skêr gevat en die naelstring probeer afsny. “Sy het dit meer afgesaag as wat sy dit gesny het”. Die suster het vir Kylie gevat en probeer om haar suurstof te gee sonder enige sukses.

Priscilla se man het om ongeveer 05h00 die hospitaal geskakel nadat hy gedurende die proses toegang tot die saal geweier is. Die suster wat die foon opgetel het, het aan hom gesê dat beide ma en die kindjie perfek is. Om 06h00 het Priscilla genoeg moed bymekaar geskraap om haar verloofde te bel en hom in te lig van die tragiese gebeure. Priscilla was gemaan om ‘n vorm te teken. Blykbaar was dit vir toestemming om Kylie se liggaampie te laat veras.

“Ek was baie deurmekaar en bitter ontsteld so ek was nie konstant bewus van wat om my aangaan nie”.

Om 14h00 dieselfde middag het sy aanspraak gemaak op Kylie se liggaampie aangesien sy haar wil begrawe. Die suster het haar meegedeel dat sy eers moet gaan uitvind of die lykie nie reeds vernietig is nie. Om 15h00 het die suster teruggekom en haar ingelig dat Kylie se liggampie nog in ʼn ander vertrek lê. Sy het toe haar man en dogter onder in die hospitaal gekry waar hulle gewag het om Kylie se liggaampie te sien. Teen 16h00 was die liggaam steeds nie beskikbaar nie omrede sy steeds in die babasaal gelê het.

“Hulle het my kind met geen respek hanteer nie, sy was in die babasaal net op ‘n bedjie gesit vandat hulle haar van my af weggeneem het”.

“Ek het baie gebloei tydens ek gekraam het. Ek is ’n baie skaars bloedgroep (O-). Ek kon self soos my kind gesterf het aangesien daar geen hulp was vir beide van ons nie”. Die suster het klaarblyklik heeltyd probeer om Priscilla te oortuig dat haar dogtertjie stil gebore was. “Ek, sowel as die pasiënt langs my, asook die eerste suster wat kom inloer het weet dat Kylie nie dood gebore was nie en dat sy wel gelewe het, al was dit net vir vyf minute. Sy het baie sterk beweeg en as iemand op my hulpkreet gereageer het was daar dalk ’n kans dat sy wel kon gelewe het”.

Volgens die ma het die volgende gebeur: toe die laaste suster ingekom het, wat die slegte nuus gedeel het, het sy ook vir die ander suster en pasiënt na bewering aangeraai om eerder niks oor die voorval te noem nie.
Priscilla en die pasiënt het aanhoudend vir die suster gesê dat Kylie wel gelewe het maar die suster het net gereageer deur te sê dat sy dood gebore is. “Sien jy die kleintjie is dood, sien jy die kleintjie is dood” is wat die suster gesê het.

“Ek het daar gesit en hulpeloos gevoel. Ek moes toekyk hoe my kind dood smoor en ek kon niks daaromtrent doen nie. Ek wou op ’n stadium haar optel en lug in haar longe probeer kry maar ek was so bang dat ek die situasie vererger” vertel sy huilend”. Ek wil nie geld hê of enige iets nie. Ek wil net hê iemand moet boet en verantwoording aanvaar. My kind het nog gelewe en ek weet dit”.

Kylie is op Vrydag, 22 September in Johannesburg tot ruste gelê.

Streeknuus sal die saak verder opneem met die Departement van Gesondheid om hul sodoende die geleentheid te gee om hulle kant van die saak te stel.

Artikel verkry deur BKA-blad


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Security guards denied woman entry at Steve Biko Academic Hospital to see dying mom

Health authorities were on Tuesday scrambling for explanations on why security guards denied a woman entry to Steve Biko Academic Hospital to say goodbye to her dying mother.

All the provincial Department of Health could say was that it would try to ascertain the facts around the allegations made by Laetitia Musiker.

The woman wept uncontrollably as she spoke of her battle to gain access to the hospital, having earlier been phoned and asked to rush there as her mother was dying.

On arrival, Musiker alleged security guards insisted that she joined the queue of visitors. While she battled to convince the security personnel to allow her in, her 84-year-old mother, Joanna Fraetas, died.

“I had just wanted to thank her for everything and that I loved her because she deserved to hear that in her last moments, but I was denied that chance,” said a sobbing Musiker.

She told the Pretoria News she received a call from the hospital at about 10am. Medical staff told her to rush to her mother’s bedside as her state had worsened and she was going to die.

Musiker, 63, dropped everything and drove from Newlands in Pretoria east. She found traffic congestion at the main entrance of the hospital as the 11am visiting period approached. “I saw people driving from the right lane being let into the hospital without a hassle, but when I got there the security guards refused to let me in.

“I explained to them that I had received a call from the intensive care unit that my mother was dying, but they would not hear any of it. Instead they told me to join the long queue.”

She said she begged the security guards to check with the hospital staff, offering the number she had been called from, to ascertain if she was telling the truth or not, but that also was not good enough.

Musiker broke down and wept as she recalled the scene caused by the security guards, whom she said started being abusive and threatened to hit her and confiscate her phone if she took pictures of them.

“As they threatened me, I parked my car on the side and walked inside the hospital where I met the in-house security manager, who told me it was illegal to park where I had. I explained my situation to him and he told me I should go move my car, but we first needed to check at the ICU to see if I was telling the truth about my dying mother. When we got there she was already gone,” she said.

“I knew this was going to happen, but all I wanted was to be there with her. I blame them for taking that moment from me.”

Muskier said the argument with the security guards lasted longer than 45 minutes – time she could have spent with her mother.

What made it more painful for her was that being denied entry at Steve Biko was not the first experience for her. She claimed that the first time was in May when her mother had been admitted after being hit by a car. At the time she was denied entry to check how her mother was doing, she said.

Her mother had developed a flesh-eating infection during that stay, and that was what eventually killed her. “She lay in intensive care for two days before she was taken into a general ward. She got the flesh-eating bacteria from this hospital and that is what has now taken her life,” she said.

Before her mother was admitted to hospital in May, she was a healthy person, Musiker claimed.

“She had never been to a doctor; she had been in perfect health, never taken a pill, not even for a headache. She could outrun me, but when she got here she got the horrible bacteria.”

When Muskier returned to her car after eventually managing to see her mother’s body, she found it clamped. She had to spend more time arguing with security guards, the time she said she could have used to grieve for her mother.

By: VIRGILATTE GWANGWA/IOL News


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GAUTENG HEALTH OFFICIAL ADMITS BEING NEGLIGENT OVER ESIDIMENI TRAGEDY

A senior Gauteng Health Department official who headed the Life Esidimeni project has admitted that he was an irresponsible and negligent leader.

Levy Mosenogi is testifying on Wednesday during the arbitration process between the State and families of victims of the Esidimeni tragedy.

One-hundred-and-eighteen psychiatric patients died after the department terminated its contract with the Life Esidimeni group last year.

Mosenogi is on the stand for a second day.

He admitted on Tuesday that he was pressured by former MEC Qedani Mahlangu and her HOD.

Mosenogi also conceded that grave mistakes were made by the government and that he regrets everything that happened in the Esidimeni tragedy.

Today he’s told the hearing that some patients were moved to NGOs without identity documents and grants.

Retired Deputy Chief Justice Dikgang Moseneke and Legal Aid South Africa’s Lilla Crouse then asked him if he agrees that this was reckless.

Mosenogi says he doesn’t believe Mahlangu fully understood the situation leading up to the tragedy.

He was asked by Moseneke whether he was afraid of his superiors.

“I was not scared but maybe the Department of Health must be run by people who know health, it would have been far better.”

Mosenogi says Mahlangu, who is a qualified teacher, was not sensitive enough to the situation.

“It was difficult to raise [the issues with] the MEC because maybe we are trained differently, I don’t know.”

Families of the victims have asked that Mahlangu be subpoenaed to testify.

His cross-examination continues.

By: Times Live


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Mediese selfbetalings styg met skokkende 13,4%

Die brood het gekrimp, maar ons betaal nou meer daarvoor.

Só het ’n ekonoom die verhoging van meer as 13% in selfbetalings deur mediesefondslede die afgelope jaar beskryf.

Verbruikers wat elke jaar swaar trek aan die premies vir hul mediese fondse het boonop nog verlede jaar R29,7 miljard uit hul eie sak opgedok.

Dit is 13,4%, of ’n hele R2,5 miljard, meer as die vorige jaar, toon die jongste jaarverslag van die Raad op Mediese Skemas (RMS).

Boonop word dié syfer onderskat omdat dit net bereken word op die rekeninge wat lede indien waarvoor hulle self betaal het.

Die selfbetalings is die bedrae waarvoor geëis is wat fondse nie betaal nie.

“Dit kan ’n onderskatting wees van die werklike bedrag wat self betaal word omdat lede nie altyd hul eise aan hul fondse stuur wanneer hul voordele opgedroog het nie,” het die RMS in die verslag gesê.

Johann van Tonder, ’n ekonoom en navorser vir Momentum, het gesê mediese inflasie meet nie die styging in bybetalings nie, maar meet net die styging in bydraes tot fondse .

Dis normaalweg so rondom 8% – al klaar bo verbruikersprysinflasie.

“Dis so goed die brood se prys styg met 8%, maar die brood krimp met 10%,” het hy verduidelik. Dit is só omdat die styging in selfbetalings te doen het met voordele wat krimp.

Damian McHugh, hoof van bemarking en verkope van Momentum Health, het ook verlede week gesê die voordele in die bedryf het oor die jare verminder.

Van Tonder sê as na die patroon van besteding van verbruikers gekyk word, kan gesien word hulle het al drasties ingekort op duursame goedere en reise en selfs op onderwys, maar mediese uitgawes spring.

Volgens hom is dit een van die redes hoekom mense minder spaar vir aftrede en hoekom mense meer leen, want hulle kan mediese uitgawes nie beskostig nie.

Hy het gesê wat met mediese fondse gebeur, is besig om deur die hele Suid-Afrika te gebeur.

Talle berigte is al die afgelope jare geskryf oor byvoorbeeld sjokoladestafies wat kleiner word, maar die pryse is hoër.

“Selfbetalings moet saam met die bydraes gemeet word,” het hy verduidelik, om die werklike impak van mediese inflasie te verstaan.

“Dan kom mense by ’n baie groter gewig van medies in die inflasiemandjie uit.”

Van Tonder het gesê mediese uitgawes maak ’n al hoe groter deel van mense se besteding van hul inkomste uit.

“En dit verklaar baie ander goed, soos hoekom mense hul polisse laat vaar en dieper in die skuld raak en minder spaar.”

Kyk na die meegaande grafiek om te sien waarop die meeste van die geld bestee word. Dit stem min of meer ooreen met die eise uit mediese spaarrekeninge. Die meeste van die geld is op medisyne bestee, want die bydraes tot mediese fondse gaan meestal na hospitale en spesialiste.

Mediese selfbetalings styg met skokkende 13,4%

Deur: Netwerk 24


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Government clampdown on private ambulances looms

Durban – Stringent regulations would soon be in place to control the private ambulance services industry, and recommendations have already been accepted by the National Health Council.
Some of the recommendations include:

– all private emergency rescue vehicles to be painted in one colour;

– one contact number for all private ambulance services;

– the nearest ambulance responds to the scene; and

– no provincial demarcations for the different private ambulance services.

This is likely to receive resistance from the operators, Health Minister Dr Aaron Motsoaledi said this week.

In an exclusive interview with the Daily News, Motsoaledi said the department was looking at getting rid of untrained operators who had been contributing to the number of patient injury complications as a result of reckless handling of accident victims.

He said some ambulance companies employed unethical practices when arriving at accident scenes.

“We have been painfully aware of the problems inherited by the department due to the manner in which some of these companies operate. When they get to the scene they don’t rush to check the pulse on patients, they rush for the patients’ pockets.

“They check if patients have medical aid or a credit card. I once said the system used by these private ambulance services can be brutal and worse than the one used during the apartheid system. In the current system, if the patients do not have one of the two cards (medical or credit), they are in trouble,” Motsoaledi said.

He said he had sent a task team to various parts of the world to assess how private ambulances operated and the recommendations of the team have been accepted by the National Health Council.

Leading the team was Professor Lee Wallace, the head of the Division of Emergency Medicine at the University of Cape Town.

Motsoaledi said the team had since submitted its report and recommendations.

“It took the team three years to do the job and their report and recommendations have been accepted by the National Health Council, the highest body in this department. The next step now will be to include the recommendations into the National Health Insurance Bill. It’s going to happen and nothing is going to stop that,” Motsoaledi said.

He said “fly-by-night” private ambulance services abused Sub-Section 3 of Section 27 of the Constitution.

“Section 27 stipulates that health care is a right. Subsection 2 stipulates that the state must do everything within its available resources to ensure that right is adhered to. Subsection 3 is what the fly-by-nights are abusing, which stipulates that nobody may be denied emergency services. Strangely, these unscrupulous operators rush for the pockets of the patients instead of saving lives.

“An ambulance nearer the accident scene must attend to the injured, irrespective of which area of the country it operates from. We also want the private ambulances to have the same colour.

“On this one, a meeting has been proposed by the operators in a threatening tone. They say one colour for all will kill their brands. The team also recommended that there should be no border for ambulance operators,” he said.

The Daily News reported last week that a Ladysmith doctor, who also owns a private ambulance company, had his firearm confiscated by the police for firing a shot into parking area of a private hospital and for pointing his firearm at a competing private operator. They were involved in a scuffle over a patient. The case is still under investigation by the police.

Some ambulance operators said regulating the industry was long overdue.

Rescue Care paramedics spokesperson Garrith Jamieson welcomed the imminent regulation of the industry but was not happy about sharing the same colour with the rest.

“We have literally seen fist-fighting at crash scenes over patients. If you are critical after an accident in Durban Central you are in trouble. Emergency vehicles are not cleaned properly and this results in infections. Handover of vehicles after shifts is done on street corners, with Johannes Nkosi (Alice) Street being the most favoured.

“However, we cannot be happy with the colour issue as this will damage our brand. We are aware of these recommendations and we will look at those areas that require attention for action,” he said.

Crisis Medical Ambulances said the standard of service had changed from patient care to money-making. Spokesperson Kyle van Reenen said: “It’s all about who loads the most patients. I’ve seen weapons drawn at accident scenes. Fly-by-nights go for those with minor injuries while the critical are left behind. The turnaround time for the less injured serves their purpose of being on the road as quickly as possible. Regulating the industry is really needed.”

Dr Vusi Memela, a Board of Healthcare Funders member, said the regulation of the private operators should be accompanied by a code of conduct to ensure that ambushing one another and pointing of firearms at competitors is minimised.

Daily News


 

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How your medical bills may change under the National Health Insurance

Many private hospitals will be opening their doors to more patients but does that mean you’ll be stuck at the back of the queue?

The United Kingdom’s universal healthcare system, known as the National Health Service (NHS), had a problem: By the early 2000s, a growing number of elderly patients were waiting up to three years for sight-saving cataract services in the early 2000s.

But the government-funded healthcare scheme didn’t have enough beds. It did, however, have plenty of parking.

“All we needed was a parking lot and a connection to three-phase electricity,” remembers South Africa’s Netcare CEO Richard Friedland.

Netcare entered the UK market fifteen years ago. It operates more than 50 private hospitals in the country, but 43% of its patients come from the NHS through the service’s electronic “choose and book” appointment system: Patients elect where to go for care, and the NHS pays private providers like Netcare a nationally-set rate for service.

Through co-operating with the NHS, Netcare helped to drastically shorten the cataract waiting lists.

To do this, Netcare flatbed trucks travelled UK highways carrying a kitted out trailer for cataract operations. Two trailers each were dedicated to operating theatres, pre-operating wards and examination rooms. Netcare offloaded these trucks into 30 NHS parking lots around the UK where they became mobile cataract clinics as part of an NHS tender.

As the lorries cruised around six days a week and 50 weeks each year, pensioners tracked their progress online, mapping out when the trailers would be in their area and booking appointments.

Ultimately, Netcare’s cataract caravans had performed more than 40 000 surgeries over [five years. Patients were sent home the same day, and many had spent just 10 minutes under the knife as surgeons slashed operating time, says Friedland, who was speaking at this week’s South African Hospital Association (Hasa) conference in Cape Town.

“Eventually the doctors were doing 20 to 24 surgeries per day in these theatres, and they were finishing at lunchtime and going home,” testified Netcare’s director of strategy and healthcare policy Melanie Da Costa before the Competition Commission Health Market Inquiry in 2016.

The past, present and future of private health?

The UK’s past could be South Africa’s future.

In June, the health department released South Africa’s National Health Insurance (NHI) white paper. The document will guide the country’s move to universal healthcare coverage – giving everyone in the country access to the same health services, regardless of their income.

Under the NHI, the government will use public hospitals and clinics to provide healthcare, in addition to buying services from accredited, private providers for standard rates – much like the UK’s NHS. By doing this, the NHI will become the largest buyer of healthcare services in the country.

But the practicalities of this are still developing, and the heads of private hospital and insurance groups like Netcare and Discovery are already thinking about what private healthcare might look like in a post-NHI world – and how they may have to change to be a part of it.

The private sector could start by following Netcare’s lead in the UK, tackling waiting lists for cataracts or hip and knee surgeries, especially in rural areas, says Mediclinic Southern Africa CEO Koert Pretorius. He says a percentage of these procedures could be done at below cost prices if private hospitals could get medicines and even prosthetic limbs procured at state tender prices.

What will the NHI mean for you?

Preliminary Hasa research shows that South Africa has about 525 private hospitals and most of these are independently run or, in other words, are not part of large groups. Pretorius says these facilities could help manage nearby clinics and even school health programmes under the NHI.

The country has screened more than 3.5-million learners since health minister Aaron Motsoaledi resuscitated school health programmes in 2014. One in three children were found to have at least one condition relating to their eyesight, hearing or teeth, the minister has said.

But NHI special advisor to the national health department Vishal Brijlal admits no one knows how many of these children ever received care.

Discovery CEO Jonathan Health says this is a gap private medical aid administrators could help to mend.

He explains: “[The NHI] seeks to purchase services from a wide range of providers … that’s about procurement, about understanding cost-effectiveness and the cost and quality of services, analyzing data and purchasing effectively.

“I’m not exaggerating when I say that the medical aid scheme administrators of this country stand out in the world for their skills, systems, data analysis capacity and their health economics capabilities. You talk today about the need to urgently look at the school health programme… I can say to you within weeks, or a couple of months at most, the private funding and delivery side could arrange those services.”

But he says a lack of trust between the public and private health sectors has stalled collaborations and both parties are to blame.

“If we had a government that was willing to say let’s do 20 000 cataracts over the next [number] of months, that could be up and running in a few months. If that trust deficit could be bridged, we could benefit real people.”

Change, change, change

Trust isn’t the only thing that will have to change under the NHI.

In 2012, Netcare tried to recreate its success in the UK with mobile cataract services in the field of breast cancer with a mobile mammography unit in the Free State. Four years later, not a single patient had stepped through the van’s doors – a fact Da Costa blamed on inflexible regulations.

“We had written at least eight letters to the health professions council before we got a response and we have just had multiple, multiple requests for data, presentations, etc. To cut a long story short, we have now donated this trailer to the provincial department of health,” she told the Competition Commission in 2016.

Eleven pieces of legislation or more will have to be amended as the country introduces the NHI. Medical aids and private providers are also likely to see more regulation, which could help stem some fears about the universal health scheme.

Like South Africa, the right to health is enshrined in Brazil’s Constitution. Although the country has its version of an NHS, private medical aids still exist. Medical schemes are however subject to rules such as maximum waiting periods for doctors’ visits, exams and some forms of treatment for instance.

Denise Soares dos Santos is the CEO of Brazil’s Beneficência Portuguesa de São Paulo – a non-profit hospital that towers above one of Brazil’s most populous cities, São Paulo. Her hospital sees a mix of private and public patients. Dos Santos says maintaining a profitable mix has meant changing everything from what to offer, how they charge for it and how they talk about it.

Dos Santos’ hospital is contracted by the city to care for public patients. But that doesn’t mean the hospital provides all health to public patients.

She explains: “You have to provide what you do better. Our competency is in highly complex [illnesses] – cardiologists, neurologists, oncologists and orthopaedics. Other… hospitals wanted to do everything to everyone, and it’s not possible.

“We focus on what we do best, and as you are able to get [more patients in these areas], you achieve economies of scale. Then we are able to buy better from suppliers.”

The hospital is also increasingly shifting to “bundled billing”, or situations in which patients are billed for group of related services needed to treat one illness with the aim of, for example, reducing costs and promoting cooperation among medical teams. Brazil’s national public health service already uses this simplified billing system – a method that might be catching on in South Africa where many providers still bill for each service separately.

Recently, Dos Santos’ hospital changed its 158-year-old logo, a blue old-fashioned cross paired with grey lettering, for a new abbreviation “BP” in dramatic red and purple. It followed market research that showed a dearth of competitors with branding in a similar hue. It’s one of the ways that BP is changing the way it speaks about itself and who it speaks to: to both private and public clients. Public patients now make up 60% of its business. BP is also introducing sub-brands so that it can specially tailor messaging and education to an increasingly diverse patient pool.

People, she says, want quality health care but they also want care that can speak to them whether they are on medical aid or not.

By: http://bhekisisa.org


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Kundiges in gesondheidsbedryf krap kop oor toename in hospitalisasie

Kundiges in die gesondheidsbedryf het op die jaarlikse konferensie van die Hospitaalvereniging van Suid-Afrika (Hasa) in Kaapstad hewig van mekaar verskil oor wat die redes vir ‘n skerp toename in die koste van mediese skemas is.

Matthew Prior, hoof van gesondheidsbeleid van Life Healtcare, sê ’n toename in benutting van gesondheidsdienste word die afgelope jare as die hoofoorsaak beskou vir hoë mediese inflasie. Hy sê die premieverhogings wat mediese skemas van hul lede eis, is die werklike maatstaf van mediese inflasie vir verbruikers.

Prior het die debat gelei oor die redes vir die toename in die benutting.

Navorsing deur Medscheme, die administrateur van mediese skemas, toon daar is ’n verband tussen ’n toename in hospitaalbeddens en die skerp styging in hospitalisasie wat verlede jaar ervaar is, sê dr. Jenni Noble, hoofbestuurder van Medscheme.

Die mededingingsowerhede se paneel wat die markondersoek na die gesondheidsbedryf doen, het in 2016 ’n verslag uitgereik oor die faktore wat die koste van mediese skemas opjaag.

Ander faktore speel ‘n rol

Mariné Erasmus, direkteur van die gesondheidsekonome Econex, sê daar is aan die vraag- en die aanbodkant faktore wat tot die toename in benutting lei.

Navorsing wys egter die grootste dryfvere is faktore aan die vraagkant.

Die vraag wat deur verskaffers veroorsaak word, is boonop ’n “baie klein deel van die faktore wat aan die verskaffingskant” benutting verhoog.

“Wanneer gepraat word oor benutting wat toeneem en die koste wat daarmee geassosieer word, is dit ’n wyer debat as net die getal hospitaalbeddens wat toeneem.”

Sy sê die faktore aan die vraagkant sluit in dat lidmaatskap van mediese skemas nie verpligtend is nie en die impak wat voorgeskrewe minimum voordele (VMV’s) het.

Erasmus sê dit is faktore wat met regulasies aangepak kan word.

Noble sê hiervolgens kan meer as 50% van opnames in hospitale nie verklaar word deur faktore soos ouderdom, geslag, chroniese siektes en lede van mediese skemas wat van een plan na die ander skuif nie.

“Die vraag is dus, wat veroorsaak hierdie ekstra toename?”

Volgens haar het Medscheme navorsing gedoen nadat baie mediese skemas in 2016 ’n skerp toename in hospitaalbesteding ervaar het. Hulle het probeer uitvind watter faktore aan sowel die vraag- as die aanbodkant daartoe lei.

Daar is niks spesifiek aan die vraagkant gevind waaraan die toename in hospitalisasie toegeskryf kon word nie. Faktore soos ouderdom en die siektelas van die bevolking het nie skielik skerp toegeneem nie, hoewel dit voortdurend styg.

Daarom is navorsing gedoen om die verhouding tussen die getal nuwe beddens en hospitalisasie te ontleed om te bepaal of dit ’n rol aan die vraagkant kan speel. Volgens haar het hulle wel ’n verband gevind tussen die toename in beddae en die getal nuwe hospitaalbeddens wat in gebruik geneem is.

Probleem moet beter nagevors word

Roly Buys, ’n konsultant van Mediclinic Suider-Afrika, het gemaan teen ’n oordeel vel oor die hospitaalbedryf op grond van inligting wat nie behoorlik nagevors is nie.

Volgens hom is “verskaffersgedrewe vraag” ’n onderwerp wat moeilik is om na te vors en baie literatuur daaroor is “hoogs verdag”.

Hy beskryf ook die verslag van die markondersoek waarna Noble verwys het, as “hoogs verdag” omdat van die data oor hospitaalopnames gedupliseer is en dit die bevindinge oor verskaffersgedrewe vraag oordrewe laat lyk.

“Ons stem almal saam daar word ’n verskil in benutting gesien, maar die probleem moet presies bepaal word voordat ’n oplossing gesoek word.”

Hy sê in Suid-Afrika word alles wat nie verduidelik kan word nie oor stygende benutting aan verskaffersgedrewe faktore toegeskryf, maar bedrog en vermorsing asook nuwe tegnologie kan ook ’n rol speel.

Hy sê as verskaffersgedrewe faktore bekyk word, moet ook gekyk word na die rol wat dokters speel.

Hy meen die rol wat mediese skemas se voordeelontwerp in ’n toename in hospitalisasie speel, moet ook bekyk word.

Volgens Noble het die getal hospitaalbeddens in die land van 2010 tot 2016 met 22% toegeneem. Terselfdertyd het die lede van mediese skemas net met 6% toegeneem.

Die toename in nuwe beddens was nie om ’n tekort aan te vul nie. Suid-Afrika het in die private sektor sowat vier hospitaalbeddens per 1 000 mense wat verseker is deur mediese skemas. Dit is amper dubbeld die internasionale standaard.

Boonop word verwag in 2017 gaan nog 500 nuwe beddens in nuwe hospitale bygevoeg word.

“Daar is ’n verband wat ons nie kan ignoreer nie, gegewe die voortgesette toename in hospitaalbeddens en die feit dat ons waarskynlik reeds genoeg beddens het. As ons die volhoubaarheid van private gesondheidsorg wil bespreek, kan ons nie ons kop in die sand begrawe en sê die toename in hospitaalbeddens dryf nie die vraag nie.”

Deur: Netwerk 24


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#HASA2017: NHI needs to start delivering now

South Africa can’t wait for the final National Health Insurance (NHI) system in 2026 to start delivering on universal health coverage, but needs to start implementing projects and programmes that will make a real difference in people’s lives now. And this can’t be done without cooperation between the public and private health sectors.

This was the overarching message in a high-level panel discussion of chief executives from the private healthcare sector at the Hospital Association of South Africa (Hasa) conference currently underway at the Cape Town International Centre.

White paper is not enough

“NHI, in principle is the right thing to do, but implementation is the key,” said Vishal Brijlal, National Department of Health (DoH) advisor on NHI. “We have a white paper, but that is not enough. The policy needs to be followed by planning, implementation, and cooperation.

“We can’t just wake up on 1 April 2026 and hope by some miracle that NHI will be in place. The question is where do we start? With those who don’t have cover or those who do?”

On the burning question of how NHI would be funded, Brijlal added that there was no clear answer on the mechanism.

He outlined the DoH’s priority programmes, including maternal health, cancer screenings and diagnosing and treating cervical, breast and paediatric cancer, school health, and care for the elderly and the disabled, and mental health screening.

Healthcare of a decent quality

Dr Jonathan Broomberg, CEO of Discovery Health, said the basic principle of universal coverage is access to healthcare of decent quality, and that this right was being denied to many South Africans. “There are literally hundreds of variations of universal coverage, and each system has to evolve to address current realities in the country the system is being implemented. The danger is we continue to have theoretical debates and do not do what we need. We are out of time and cannot afford to lose this opportunity. We need to focus on what we can do today to benefit people, rather than some idealised NHI endpoint.”

All efforts to build a sustainable society would stumble without a strong and sustainable healthcare system – and the South African system is “incredibly” unequal, but that the widespread knowledge gained from local private hospitals international operations are invaluable to South African healthcare reform, said Dr Richard Friedland, Netcare Group chief executive officer. He cited the case study of Netcare’s United Kingdom group reducing cataract treatments from more than a day to mere hours, using mobile clinics and doctors with extensive experience in this procedure.

Trust deficit

However, there is a trust deficit which hinders between the private and public sectors, said Broomberg.

Koert Pretorius, CEO of Mediclinic Southern Africa agreed, saying: “There is better trust at provincial level.” He explained that the weekend surgeries initiative, where the private sector provides its spare capacity to help clear the backlog of public sector procedures, such cataract operations and tonsillectomies, was already working.

He added his company had conducted research into what he termed the middle market of uninsured people. This group earned between R6,400 and R16,000 (representing about seven million of the national population), had a high incidence of non-communicable diseases, and are willing to pay up to R350 per month for primary care. This group could be covered for 45-50 conditions at this price, which could represent 85% of basic healthcare needs.

Here, private sector could offer its spare capacity to the public sector and treat a percentage of prioritised cases at a lower cost.

Training

Another obstacle that needs to be addressed is the chronic shortage of healthcare professionals, which affects both sectors. “We need a proper HR audit for a better understanding of the shortage,” said Pretorius.

“The nursing backlog could be cleared in eight years if the private sector was given more capacity for training,” said Friedland. He suggested that the regulations stating that doctors can’t be employed or trained by the private sector needed to be reviewed.

Pretorius concluded that South Africa won’t ever achieve universal coverage without the private sector.


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