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Interesting articles about the Medical Aid industry and Medshield position in it
Posted in Medshield Medical Scheme   |   May 13th, 2020
Opinion article by Thoneshan Naidoo, Principal Officer of Medshield Medical Scheme
Unsurprisingly, those who can afford private healthcare cover, are questioning whether their medical aid will cover the diagnosis and treatment of Coronavirus COVID-19. Some medical schemes in South Africa have aired their views on the matter and offered emergency interventions for this issue. However, overcoming a pandemic of this nature requires a honeybee mind-set.
Honeybees are highly evolved social insects that live together in large, well-organised family groups and engage in a variety of complex tasks for a common purpose. Communication, complex nest construction, environmental control, defence, and division of the labour are just some of the behaviours that honeybees have developed to survive successfully in social colonies.
Relating this analogy to healthcare means that for us to overcome this pandemic requires a unified solidarity response, backed up by a strong eco-system consisting of monetary reserves and funding, qualified and available medical professionals, necessary technology to carry out the services, and the support of industry regulators.
Pooling resources for better healthcare
This is not a public sector or private sector issue, this is not a selective crisis, COVID-19 is a national crisis and we all need to work together as South Africans. Recognising that South Africa’s healthcare system – both public and private – has limited capacity, the appropriate utilisation and timing of required healthcare intervention have an important impact on healthier outcomes. In support of this, Medshield organised for members to access their current Doctors via remote consultation (telephonic and video) – without having to consult physically in the Doctor’s rooms. This allows for ease of capacity on the healthcare providers, and ensuring more people are helped.
As the number of COVID-19 positive patients increases daily, there is a need to rapidly increase and speed up the testing. At Medshield, we decided to donate a Hyundai H1 panel van as well as R500 000 to the National Institute of Communicable Disease (NICD) to assist with this initiative. Collaboration with the government is critical to address this national pandemic, and to reach and test more people in South Africa. The NICD has warned that the pandemic is evolving in the country, as it has moved from the importation of cases to the low-level local transmission where people, who have not yet been tested for the virus, are spreading it to their families and other contacts, and alarmingly asymptomatically in a number of instances. Can we afford the financial costs of a wider spreading of this disease, and do the rules and regulations allow us the flexibility to put people first?
Coverage and financial preparedness
We have always aimed to stay abreast of potential challenges such as this at Medshield. As a not-for-profit organisation, we worked hard to ensure that our vision of ‘Caring about YOU towards a healthier nation’ is fulfilled by being prepared in advance. Current claims experience suggests that the cost for a COVID-19 hospital admission is in excess of R150 000, but Medshield is well placed to weather this storm for and with our members. With a solvency ratio of 40% (significantly higher than the mandatory 25% and considerably higher than most of the competing open schemes) we ensure that we can meet the demands of increased hospitalisation and heightened burden of care due to COVID-19. Our focus has been to unlock three things: increasing access to healthcare, ensuring quality of care, and making sure it’s affordable.
Prescribed Minimum Benefits (PMBs) are predetermined conditions that a scheme covers under its benefit offering. These are regulated by the CMS, and we are encouraged that the CMS has recently declared that all cases of COVID-19 are regarded as PMB conditions and should be funded in full in line with the current NICD guidelines. Medshield however, embraced the cover for COVID-19 as a PMB long before it became the norm to do so. As a Medshield member, when visiting a healthcare professional, or being tested for the COVID-19 virus, the costs will be paid from a member’s Day-to-Day/Savings Limit (depending on the chosen benefit option), whether the diagnosis is positive or negative. If the test is positive, Medshield covers the diagnosis, treatment and care costs from the Risk Benefit pool as a PMB, irrespective of one’s chosen benefit option – in other words, these costs will not be paid from one’s current 2020 benefits.
For most households, medical aid contributions are one of the biggest monthly budgeted expenses and we have seen an influx of suggestions for the opportunity to cut or reduce this expense. The loud request for premium holidays could result in even bigger financial problems in the months to come, while creating complex administrative issues and potentially exposing our members to risks of uncovered healthcare expenses when they need it the most. In essence, it takes the equivalent of 75 non-claiming members’ monthly contributions to cover the cost of one critical COVID-19 hospital admission. Therefore allowing premium holidays while paying out medical claims creates a cascading effect of large financial deficits. Medical schemes that are constituted as not-for-profit entities will need to hike members’ contributions to cover these large deficits, which in turn has a knock-on effect on affordability for members. This illustrates that in a highly complex eco-system such as healthcare, having a single-minded perspective is actually detrimental to the overall solidarity purpose.
Focussing on the people will lead to better outcomes
We are at the onset of the seasonal flu and with the COVID-19 impact, it is more important than ever, especially for high-risk members, to get the flu vaccine. The elderly (over 60 years old), and members with compromised immune systems, or underlying conditions such as cardiovascular disease, respiratory conditions, and diabetes, amongst others are at huge risk. Timing is crucial. High-risk members who get infected with the virus are likely to require critical healthcare, but through the preventative and social distancing measures we as South Africans are practising, the timing of their healthcare intervention could be staggered over a longer timeframe of 3 to 6 months. This allows our healthcare system to better cope with the demand of the critically ill at the right time, resulting in overall better and healthier outcomes for all.
We are proud of our President’s and government’s swift action to mitigate the impact of this crisis. In a demonstration of unity with the President’s gesture, I am pledging 30% of my nett salary for the next three months to the Solidarity Fund to assist with the fight against COVID-19. We are indeed all taking strain economically, with Moody’s recent announcement of South Africa’s economy downgrade to “junk status”, but we can always resuscitate a strained economy. We are in this together and we need to overcome this crisis together. Just like honeybees, each member has a definite task to perform, but surviving takes the combined efforts of the entire colony. Individual honeybees cannot survive without the support of the colony, which cooperate in nest building, food collection, and brood rearing – and that is the solution we need to whole-heartedly embrace and adopt in conquering this pandemic.
 Circular 25 of 2020: COVID-19 lockdown measures by the Council for Medical Schemes’ (CMS) available at https://www.medicalschemes.com/files/Circulars/Circular25Of2020.pdf
This post and content is sponsored, written and provided by Medshield.
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