There are many ways medical aids can help their members live healthier lives.
Private healthcare is making headlines as a result of the National Health Insurance (NHI) Bill released in August, followed by the Health Market Inquiry report and ‘launch’ season for medical aids, when schemes present their new or revised products and benefits for the year ahead and notify members of contribution increases.
But the South African healthcare landscape remains complicated. There is no doubt that access to quality healthcare for all citizens is a priority and the intention of the Department of Heath to introduce NHI has our fullest support. However, we believe more debate and engagement among all stakeholders – including employer groups – is required to make sure the process is fair, participatory and transparent, ultimately resulting in a NHI Bill that will ensure a sustainable, quality healthcare solution for all South Africans.
The Bill outlines a transitional arrangement, which means NHI will not happen overnight – until then it is business as usual in terms of private medical schemes.
Bearing this in mind and taking into account the impact of the current socio-economic landscape, our focus is to add value while balancing costs. This means the increases for 2020 range from just 6.2%, with an average increase on risk contributions of 9.4% and a weighted increase of 9.9%.
We know that a healthy workforce is a productive one which is why there has been a distinct shift towards making employee wellness a serious focus to address work-life balance and maintain employee health. Many organisations offer comprehensive employee wellness programmes. To enhance and support organisations further, we have contracted Wellness Odyssey as our partner. Together we will manage the health of employees actively by providing access to comprehensive health risk assessments in the workplace. These include a lifestyle assessment, seasonal flu vaccinations, TB, optometry and prostrate screening as well as clinical breast examinations and mobile mammograms. All services are delivered on site to avoid disrupting the work environment.
For 2020, we are placing an increased emphasis on our Managed Care programmes. Combining wellness screening with managed care initiatives allows us to empower members on their health status and allowing members to take proactive steps before the onset of serious health complications. Part of the managed care programmes include:
Chronic medication: a home delivery service for chronic medication to help members adhered to their medicine regiments – no more queuing for medication at a pharmacy. Around 187 000 members are enrolled on the chronic medicine programme.
Mental health: Mental health is drawing renewed attention with the World Health Organisation revealing that depression is the leading cause of ill health and disability. With work-related stress and healthcare costs on the rise, our Mental Health Programme (MHP) becomes important. It is education driven and aimed at empowering people with mental health issues to manage their condition while offering support to their loved ones.
Back and neck: Back, neck and shoulder pain is a common problem – 80% of us will experience an episode at some point in our lives. It is caused by an injury, a disc or joint problem, an irritated nerve root, poor posture or the result of stress and lifestyle specific issues. Failing to get pain relief can lead to depression, loss of working hours, extensive treatments and sufferers often resort to popping painkillers or going for surgery, both of which can be counterproductive. That’s why we’ve partnered with DBC to provide access to a back and neck programme of up to six weeks, to either prevent surgery or, when unavoidable, prepare and strengthen ahead of surgery and rehabilitation afterwards. The DBC back and neck programme has a 91% success rate and only 5% required surgery.
Run/Walk for Life and Eat for Life
The top four conditions suffered by our high risk members are hypertension, diabetes, high cholesterol and heart disease. These conditions can be significantly improved by exercising regularly and eating a healthier diet. We have partnered with Run/Walk for Life and Eat for Life and are offering members a 70% discount.
Enhanced Wellness Extender
One of the key initiatives for 2020 is an enhanced Wellness Extender benefit to include, amongst others, blood tests and x-rays available on all options, except BonCap, without impacting on day-to-day benefits or savings. This can be used across a range of services from GP consultations to physiotherapy and blood tests, and will be paid from the Wellness Extender first, so members can stretch their benefits further.
Our partner is expanding screening locations to include Dis-chem and Clicks clinics, as well as offering various activations and family wellness days in remote areas.
More value for members
In looking at our members’ needs, it’s clear they require additional out-of-hospital benefits for daily medical and day-to-day expenses such as acute medicine, blood tests and x-rays. On some plans, day-to-day benefits have been increased while on others the savings portion has been increased – the benefit increases range from 16 to 20%. On other options, the dental benefit has been restructured and, in some cases, GP visits have been increased.
We have introduced a range of enhancements for members as well as introduced some value adds.
The way forward
There are multiple factors that impact the cost of healthcare, some more controllable then others, but we can’t sit back and lay blame. We need to constantly find innovative methods to reduce costs while offering our members maximum value for money. We believe we are achieving our mandate and getting this balance right.
In fact, we are exploring ways of improving accessibility to services such as telemedicine. Instead of members going to the doctor, they can call a nurse or doctor that will give them peace of mind about their symptoms and whether they need a face-to-face consultation or get the correct over-the-counter treatment. In some pharmacy clinics, the nurse is able to have a video consultation with a doctor, from a mobile device, and get additional assistance, which saves the member time and money.
We encourage employers to consult and work alongside corporate brokers to compare and assess the various options, to find the most suitable and cost competitive medical aid plan that works for their employees and families.
Despite difficult trading conditions, we are pleased to have seen a growth in membership. We believe this is due to us offering members what they want. We want to help them live their best, healthiest life and offer them value for money when it comes to quality healthcare.
Lee Callakoppen is the Principal Officer of Bonitas.