The ma­jor challemges

Finweek English Edition - - Healthcare -

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.”

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