The major challemges
AS IN PREVIOUS YEARS, medical inflation, the burden of disease (with HIV/Aids at the forefront), new and expensive drugs, an ageing population, a shortage of professionals, forever changing legislation and currently poor investment returns due to the difficult economic climate are some of the major challenges facing the medical aid industry this year, healthcare and medical scheme executives agree.
Because of the downturn in the economy, the pressure is on all service providers to be as cost-e8ective as possible, says Bafana Nkosi, chief principal o2cer of Bonitas. Due to the challenges Nkosi says smaller agencies will 1nd it di2cult to survive. “Their only option will be to merge with bigger schemes. Also, as many companies with closed in-house schemes are a8ected by economic conditions, they’ll increasingly approach open schemes to consolidate.”
For example, BHP Billiton’s closed scheme recently joined Bonitas, which now has 260 000 principal members and just under 600 000 bene1ciaries, making it South Africa’s second biggest scheme, says Nkosi.
For sustainable even lower cost options to survive you’d need certain exemptions from the current Medical Schemes Act, he says. “Research has shown low-income members actually access and pay for medical services out of pocket. There’s a very large pool of uncovered lives who can’t a8ord the lowest cost options available in the market. The only way to create lower cost products would be through an exemption from the requirement to cover the legislated prescribed minimum bene1ts, which will push up the cost of health cover. For example, should hospitalisation be limited to State hospitals, the costs of cover could be signi1cantly reduced for that portion of the population currently forced to pay for their day to day care out of pocket.” Nkosi’s advice to cash-strapped medical aid members is to hang in there and not exclude medical aid. “During tough economic times like these people get depressed and sick – when you need medical aid the most.”