MA­TER­NITY BEN­E­FITS WITH­OUT MED­I­CAL COVER

Health­care man­age­ment com­pany launches a sin­gle-price birthing plan, writes

CityPress - - Business -

If a woman only joins a med­i­cal scheme af­ter she has fallen preg­nant, her child will be cov­ered by the scheme, but not her med­i­cal costs dur­ing the preg­nancy. That means if you fall preg­nant with­out ex­ist­ing med­i­cal cover you have two op­tions: ei­ther you rely on the state for your pre­na­tal care and de­liv­ery, or you pay for pri­vate care. If you opt for pri­vate care it is dif­fi­cult to know ex­actly how much your de­liv­ery costs will be. Even if you have quotes from the hos­pi­tal and ob­ste­tri­cian, they won’t in­clude com­pli­ca­tions or an emer­gency Cae­sarean.

The need for a more af­ford­able and man­age­able pre­na­tal and birthing plan for women not cov­ered by a med­i­cal scheme led to the cre­ation of The Birthing Team which, for a set cost, gives you ac­cess to a team of ex­perts in­clud­ing GPs, mid­wives and ob­ste­tri­cians to pro­vide holis­tic care dur­ing your preg­nancy and de­liv­ery.

Dr Brian Ruff, CEO of health­care man­age­ment com­pany PPO Serve who cre­ated The Birthing Team, be­lieves that a team ap­proach to preg­nancy sig­nif­i­cantly drives down the cost of med­i­cal care.

“The high costs in the pri­vate sec­tor are partly driven by high Cae­sarean rates which are of­ten due to poorly man­aged pa­tients as well as the fact that ob­ste­tri­cians are work­ing on their own and have to sched­ule elec­tive births as they can­not be avail­able all the time,” says Ruff.

The com­pany an­a­lysed the costs of preg­nancy on low-cost med­i­cal schemes be­tween 2014 and 2015 and found that the av­er­age cost, just for the mother’s med­i­cal bills, av­er­aged R70 000 over the two years. “We looked at the data and found that the costs were driven by the 65% Cae­sarean rate and by women who de­vel­oped di­a­betes, hy­per­ten­sion or de­pres­sion dur­ing their preg­nancy,” says Ruff, who be­lieves that ac­cess to high-qual­ity care dur­ing preg­nancy through a team ap­proach can re­duce these com­pli­ca­tions, in­clud­ing for the baby. Women who do not have com­pre­hen­sive med­i­cal cover are more likely not to ac­cess qual­ity pre­na­tal care and there­fore face higher risks in labour.

THE COSTS OF GIV­ING BIRTH

If you de­cide to give birth at a pri­vate hos­pi­tal you can ex­pect to pay R15 000 for a nor­mal de­liv­ery. This ex­cludes the doc­tor’s costs, anes­thetist if you have an epidu­ral, or any med­i­ca­tion. The cost in­creases sig­nif­i­cantly if you end up hav­ing a Cae­sarean. This does not cover the costs of pre­na­tal or post­na­tal care, which are sig­nif­i­cant.

In com­par­i­son, The Birthing Team pack­age costs R19 500, which in­cludes a min­i­mum of eight an­te­na­tal vis­its, blood tests, ba­sic medicines, short an­te­na­tal ad­mis­sion if re­quired, the birth and sixweeks post-de­liv­ery care. The fee cov­ers an emer­gency Cae­sarean if med­i­cally re­quired.

Dr Howard Many­onga, head of The Birthing Team, says a woman pays an ini­tial fee of R1 500 for the first as­sess­ment, which in­cludes phys­i­cal ex­am­i­na­tions, blood tests and scans and the de­vel­op­ment of a per­son­alised care plan.

If she has a nor­mal preg­nancy with no fore­seen health risks, the price would be R18 000 for the pro­gramme. This is payable over the course of the preg­nancy and fully paid by 36 weeks. If a woman has health risks in­clud­ing HIV, di­a­betes or hy­per­ten­sion, then she would pay a higher pre­mium of up to R27 000 to cover the ad­di­tional med­i­cal su­per­vi­sion re­quired.

“This price will not change, so you have cer­tainty and would not need to pay out-of-pocket dur­ing the course of your preg­nancy,” says Many­onga, un­less the woman de­vel­ops a se­ri­ous health prob­lem which is beyond the scope of the team to man­age. This could in­clude a preg­nancy where a pre­ma­ture de­liv­ery re­quir­ing neona­tal ad­mis­sion is likely, or the mother de­vel­op­ing a se­ri­ous con­di­tion that has sig­nif­i­cant risk for the preg­nancy, such as car­diac prob­lems. The pa­tient would then be re­ferred to a state hos­pi­tal. “As we are not a med­i­cal scheme we can­not af­ford to cross-sub­sidise high-cost care. If we ac­cept all the risk then the im­pact of just a few very high-cost cases would make the prod­uct un­af­ford­able for oth­ers,” says Many­onga.

The Birthing Team has launched in Net­care Rand Hos­pi­tal in Berea and will be launch­ing in hos­pi­tals in Dur­ban, Cape Town and Pre­to­ria dur­ing the course of the year.

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