PREVENTATIVE and primary care are in some respects two sides of the same coin.
Primary care involves visiting an appropriate healthcare practitioner when an illness first starts for first-line treatment — before the illness progresses.
Preventative care is incredibly important, and is necessary to prevent conditions or illnesses from getting worse or needing radical treatment, according to Heidi Kruger, the Board of Healthcare Funders head of corporate communications.
And though it may cost a medical scheme more money while it is putting a disease management programme together for diabetes, HIV or another chronic condition, it’s going to save medical scheme members, as well as the scheme itself, money in the long term.
BOARD of Healthcare Funders CEO says move demonstrates the government’s commitment to making private healthcare more affordable, writes David Jackson.
Health Minister Aaron Motsoaledi has announced that he is launching an inquiry into prices in the private healthcare sector through the vehicle of the Competition Commission, with a view to proposed legislation to establish a regulated pricing framework for the industry.
Reacting to news of this development, Dr Humphrey Zokufa, CEO of the Board of Healthcare Funders (BHF), says: "We believe the government is demonstrating a commitment towards making private healthcare more affordable.
MEDICAL scheme fraud, estimated at about R15bn annually, is not declining, despite greater sharing of information by medical schemes and a zero-tolerance approach by some of the bigger medical schemes such as the Government Employees Medical Scheme and Discovery Health.
Michelle David, a medical scheme specialist at law firm Eversheds, said on Friday although it had been estimated that fraud cost SA’s schemes between R4bn and R15bn, she believed it to be more than R15bn.
She said few medical schemes took part in surveys to determine the extent of fraud — only about eight schemes on average, and not the larger ones .
Medical scheme members could be left out in the cold if gap cover products were scratched because medical aid benefits were constantly shrinking, health insurance experts said last week.
Over the years, the gap in cover between benefits provided by medical schemes and what providers charge has widened not only for specialists’ consultations, but for in-hospital procedures as well.
Medical schemes have said their reduced reimbursement rates on hospital cover could be blamed on specialists who charged higher rates. This has left members to pay more from their pockets because of co-payments, sub-limits and deductibles, among other things.
Private healthcare prices in South Africa have to be regulated, Health Minister Aaron Motsoaledi said.
Speaking at the Board of Healthcare Funders conference at Sun City, Motsoaledi called for a pricing negotiation forum, saying healthcare in South Africa was "predatory".
He said the health structure was worse now than during apartheid.
"There is a tendency to believe that a long and healthy life is the right of those that can afford it and that is totally wrong," he said.
"The reality is that our people are dying in large numbers. We are running a healthcare system in this country that is not working."
The solution lay in re-engineering the primary healthcare system.
Motsoaledi announced a plan to introduce three streams of care, which would have a particular impact in rural areas.
Board spokesman Heidi Kruger welcomed Motsoaledi's comments, saying: "I think it's brilliant. The sooner it comes through the better. We can't have a situation where there is no containment on costs."
Kruger said private healthcare providers charged whatever they wanted, "pushing up" medical aid premiums.
The current system was an "open-ended liability for funders" so medical schemes could not budget properly.
Regulating healthcare costs would be "very constructive" and "provide certainty", Kruger said.
Motsoaledi is hoping to begin setting up the pricing forum by the end of the year.
However, he told delegates at the conference that hospitals were creating a stumbling block in the process because that sector did not want to have its prices regulated.
Motsoaledi accused the public and private health sectors of "engaging in destructive, unsustainable practices". He was particularly outspoken about the high cost of private hospital treatment and called for a stronger emphasis on primary care, rather than the present curative system with its "rapidly escalating" costs.
"The public health system is in a crisis of quality and I am going to deal with it head on, but it is not an excuse for profiteering," he said.
"Our country is going in the wrong direction . all of us, public and private," he said. "We have a predatory healthcare system where the sick and the vulnerable are the ones who get attacked."