Interesting articles about the Medical Aid industry and Medshield position in it
Posted in Articles   |   July 24th, 2018
There has been a marked deterioration in public healthcare that has created a pressing need for reliable and, above all, affordable hospital plans in South Africa. While the government healthcare services were once world-class, the steadily rising costs of qualified medical personnel, equipment, utilities and consumables have outstripped the capacity of the Health Ministry to raise sufficient funding. This has resulted in a number of closures and, in other cases, a need to confine the service to primary healthcare. As for the essential teaching hospitals that must still continue to operate as normal, most are now severely overburdened.
Against this background, the demand for medical care has continued to grow due to a variety of factors such as secondary illness arising from the HIV/Aids epidemic, a substantial increase in stress-related disorders and diabetes as well as the perennial rise in motor vehicle accidents. While the private sector clinics have been no less affected by rising costs than government hospitals, they are positioned to simply pass on these increases to the patient which, in the vast majority of cases, will then be forwarded once again – this time to his or her medical aid scheme.
The buck, however, must ultimately stop somewhere. The prime objective of those responsible for managing these schemes is to provide the means to ease the burden created by medical expenses. They cannot simply pass on these increases to the members if they are to continue providing affordable medical aid and hospital plans in South Africa. Inevitably some increases will be unavoidable and in order to minimise these, the schemes have had to become a lot more innovative in compiling their products.
This exercise has involved a variety of strategies and one of these has been to move away from the traditional offer of blanket cover on a one-size-fits-all basis with the evolution of products more tailored to the needs of the individual. While individual benefits are not yet available on an à la carte basis, these new products may be thought of as similar to a choice of set menus. This allows a prospective member considerably more freedom to pick a product that most closely meets his or her likely needs while saving the cost of cover for less likely contingencies.
Another strategy that has proved to be particularly effective in cushioning scheme members from the knock-on effect of spiralling healthcare costs is the formation of contractual agreements with various service providers. Typically, this type of agreement will involve a lump sum payment by the scheme to a given supplier who, in exchange, will then undertake to provide any approved treatment or services to all patients referred under the scheme, at no additional charge.
For those of limited means, the affordable hospital plans offered by medical aid funds in South Africa, are proving to be an attractive option. This type of cover assumes that the typical day to day needs can be met by the member as out of pocket expenses and thus cover only kicks in when the member is admitted to a clinic or similar facility. For younger members with no children and whose health is generally good, this type of product can represent a considerable saving while ensuring that the most expensive aspects of healthcare are covered.
Long term insurers offer a similar product that pays a fixed daily sum, determined by the premium amount, during periods of hospitalisation. It is important to note however that it’s highly unlikely to cover more than a fraction of the actual costs and may also not include the expenses incurred in treating the 25 chronic illnesses that medical aid schemes have been legally bound to meet in full since 1998. Furthermore, the schemes may not exclude applicants, who are suffering from any of these 25 listed conditions, from membership.
All in all then, the concept is a good one that offers distinct advantages for younger members in particular. It is, however, important to compare the scales of benefits paid before making a commitment to a given scheme as these may vary considerably between funds however good the product, it still amounts to only partial cover and so checking the details is vital.
Medshield has met the affordability issue with a range of 8 alternative products that make it easy for families to meet their specific needs yet still pay competitive premiums. Choose comprehensive cover or one of the most affordable hospital plans in South Africa.
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