Category Archives: Medical Aid

Information on Medical Aid schemes in South Africa

The lowdown on Covid-19 test protocols

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As South Africa finds itself starting to move out of the second wave of a Covid-19 outbreak, over eight million Covid tests have been carried out in the public and private sector since the start of the pandemic.

Image credit: United Nations Covid-19 Response on Unsplash 

The global gold standard method to diagnose Covid is the reverse transcription polymerase chain reaction (RT-PCR) test. It is currently the most accurate way to detect SARS-CoV-2, the virus that causes Covid-19. 

Will your medical aid pay for the test?

According to Lee Callakoppen, principal officer of Bonitas Medical Fund, “Funding is in accordance with the Council for Medical Schemes (CMS) guidelines, all clinically appropriate and referred diagnostic testing for suspected Covid-19 cases will be funded as a Prescribed Minimum Benefit (PMB) condition.” 

Bonitas pays for up to three Covid-19 diagnostic tests from risk, whether the result is positive or negative. However, this is subject to the member or beneficiary being referred by a registered healthcare practitioner (doctor or nurse). This referral is dependent upon whether the member is showing symptoms, has been in contact with anyone who has Covid-19 and prior to hospitalisation. 

It should be noted that laboratories will not normally accept walk-ins for testing and require a referral or request from a healthcare practitioner. This is to ensure that we don’t test unnecessarily and jeopardise the availability of these tests for those who really need them.

“Despite the PCR being arguably the most accurate laboratory methods for detecting, tracking and studying the coronavirus, there are limitations in its widespread use,” says Callakoppen. “These include access to the test kits; the complexity of performing them; the need for specialised staff to administer them; potential global shortages; high costs; the requirement for laboratory equipment and the delayed turnaround times. For this reason, testing should only be done when it is clinically necessary.” 

What about rapid antigen tests? 

Immunoassay devices that detect the SARS-CoV-2 antigen within 15-30 minutes have also been promoted as a possible solution when access to PCR tests is a challenge. An antigen – detected in the blood or any other fluid – is any substance that makes the immune system produce antibodies. Viruses and bacteria are antigens. However, these tests are not as accurate as the PCR tests and have shown variable performance during evaluations, with sensitivities ranging from 0 to 94%. Test specificity has been high, but sensitivity has been erratic, which we need to bear in mind.

Why is specificity and sensitivity critical? 

Sensitivity is the percentage of true positives (e.g. 90% sensitivity = 90% of people who have the target disease will test positive). Specificity is the percentage of true negatives (e.g. 90% specificity = 90% of people who do not have the target disease will test negative). These allow you to rule conditions in or out but not definitively diagnose a condition.

What does the Council for Medical Schemes (CMS) say?

The CMS currently still advocates the PCR test to diagnose Covid-19. The World Health Organisation (WHO) has also previously advised that the role of these rapid antigen tests must be evaluated and are “not currently recommended for clinical diagnosis pending more evidence on test performance and operational utility”. However, the WHO has now approved the use of antigen tests (and this is the South African approach as well) as an alternative to the more expensive PCR tests. This is, however, in certain defined scenarios such as testing confirmed people in communities where infections have been detected, screening of high-risk groups and individuals and for contact tracing purposes. They have also provided conditional recommendations for the use of these tests such as screening at ports of entry, routine screening for employees at their place of work, schools, prior to certain urgent medical procedures, etc.

The challenge with these tests is that they are most accurate in patients between five and seven days after showing symptoms – therefore the timing of testing becomes critical in order to ensure accuracy of the result.

What about rapid antibody tests?

Many countries, including South Africa, are using antibody or serology tests such as the ones offered at various drive-throughs. These can detect whether someone has previously been infected and estimate how widespread the infection is but they are not recommended for diagnosis of Covid-19. 

For this reason, these are not funded by Bonitas Medical Fund as the use for these tests is limited for purposes of government surveillance and research rather than diagnosing Covid-19. If individuals want to know whether they have previously had Covid-19, for their own information, this test would be able to confirm that – but it is not used to identify whether you currently have the infection.

If these tests are done too soon after the infection, they produce incorrect results as the antibodies (IgM and IgG) will not be detectable. There is also no scientific evidence that it provides any immunity to another Covid infection. 

“What is clear is that laboratory testing plays a vital role in the diagnosis and the prevention of the spread of the virus,” says Callakoppen. “Nevertheless, it is important to understand that the timing and correct use of the different types of tests is crucial to gain the best results. We reimburse up to three PCR or rapid antigen tests done in or out of hospital for our members and recommend that this protocol for testing remains, until further research is conducted and evidence provided.”

Report on racial bias by schemes against black healthcare providers released

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Image source: Getty/Gallo

The investigation was commissioned by the Council of Medical Schemes (CMS) in 2019 after the allegations were made by the National Health Care Professionals Association (NHCPA) and advocacy group, Solutionist Thinkers.

The chairperson of the independent review panel, Tembeka Ngcukaitobi, SC, presented the findings of the investigation on Tuesday. He said the panel was mandated to investigate two main issues: whether there is racial discrimination by schemes against black healthcare providers and whether black providers were being treated procedurally unfairly.

“The evidence presented by complainants and the schemes was important for the panel’s inquiry regarding how the schemes and administrators’ risk management systems, more particularly their fraud, waste and abuse (FWA) systems, worked in practice,” he said.

The panel appointed an independent specialist in statistics and data analytics as well as legal experts to assess the outcomes of the FWA investigation processes by the three main administrators – Discovery, Medscheme and the Government Employee Medical Scheme (Gems) – and to provide assistance with the legal framework to test unfair discrimination and the principles of implicit racial bias.

The panel found that between 2012 and 2019, there was a substantial difference in FWA outcomes between black and white practitioners. It did, however, not find any evidence of explicit or intentional racial bias in the algorithms and methods that the administrators and schemes use to identify FWA.

“There is no explicit use of race in the analytics process. This does not mean that the process is ‘race-blind’. It may be the case that certain factors used, or areas prioritised are asymmetrically distributed by race and that this may produce racially biased outcomes.

“There is a substantial difference in FWA outcomes between black and non-black practitioners over the period from January 2012 to June 2019. Over this period, black practitioners were 1.4 times more likely to be classified as having committed FWA than those identified as not black. The probability that this distribution occurred by chance (ie, that there is no correlation between racial status and FWA outcomes) is for all practical purposes zero.”

There are clear differences in the scale of racial discrimination between the three medical schemes, with Discovery 35% more likely to identify black providers as having committed FWA, while Gems was 80% more likely to identify black providers as guilty of FWA. Discovery and Gems are the two largest medical schemes in South Africa,” the report said.

The interdict

On Sunday (17 January), Gems and the Board of Healthcare Funders (BHF) went to court seeking an interdict against the public release of report, claiming it contained “scathing allegations and findings in relation to Gems (and others)”.

The parties said they not seen the interim report or the investigation’s terms of reference, nor had they been given an opportunity to comment on it, making the public release a contravention of the Medical Schemes Act.

In an answering affidavit, Ngcukaitobi said that from the outset the panel had made it clear that the process would be a public one and that the panel would be “accountable to the public as much as to the CMS and the parties”.

He said the applicants had made extensive submissions – written and oral – during the investigation and they knew from 27 November that the panel was going to publicly release the interim report. The urgency of their court case was “self-created”, he said.

The Pretoria High Court dismissed the application, saying that it lacked urgency.

Responses

The Board of Healthcare Funders (BHF) said in a statement that it wanted to clarify the decision to interdict the report’s release was to ensure that due process is followed in relation to the investigations by the independent panel, as well as the issue of the preliminary report by the independent panel.

BHF said that the panel did not implement the approved terms of reference nor the subsequent processes that it initially indicated would be followed.

“The BHF supports openness and transparency and the principles of natural justice that dictate that parties should be made aware of the findings made against them by an administrative body such as the panel and be presented with a reasonable opportunity to correct any errors or inaccuracies set out in any findings made by such administrative body prior to the publication of a report to the general public. This serves to ensure that unnecessary adverse inferences are drawn in relation to named parties to their detriment,” the statement said.

Dr Katlego Mothudi, managing director, BHF, conceded that the private healthcare industry is grappling with a high prevalence of fraud and corruption, which is exacerbated by lack of visible policing, gaps in monitoring systems, inappropriate consequence management processes, long-standing malpractices that have become entrenched as well as low levels of information sharing within the industry.

He said that several efforts are being made in the medical scheme industry to root out fraud, waste and corruption. In efforts to do so, BHF member schemes follow various processes to determine trends and anomalies in claims and use these to determine the outcome of claims. “We are of the view that our members have and had no agenda to intentionally discriminate any of the medical professionals, as we have a zero-tolerance to any forms of discrimination.”

Providing clarity on the interdict application, Dr Stanley Moloabi, principal officer of Gems says: “Our intention was never to ‘block’ the release of the report, but to request that due processes be followed in ensuring that affected parties had a view of the report before it was released to the public.

“Gems has a zero-tolerance to all forms of discrimination and pledges to implement corrective action where such remedial interventions are required and as recommended by the panel for the benefit of our members and healthcare providers.”

Meanwhile, Medscheme was also disappointed not to have eyes on the report before it was released.

The company maintains that its duty will always be towards its beneficiaries to validate and verify healthcare claims, and the company does not take this duty lightly. “Our fiduciary duty to safeguard funds entrusted to us remains to ensure that members and their dependants continue to receive access to healthcare treatment that is affordable and of the highest quality. This function has become even more critical in current depressing economic times, a function without which private healthcare would be substantially more expensive for everyone,” said Dr Lungi Nyathi, executive director at Medscheme.

#BizTrends2021: Are day hospitals the new trend?

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Globally, day surgery hospitals have changed the experience of patients by offering an alternative to acute/conventional hospital surgery. In South Africa, the concept is also gaining popularity – particularly as a result of high hospital costs.

Lee Callakoppen, principal officer, Bonitas Medical Fund

Using our hospital dashboard for the full 2019 year, direct hospital costs were 43% of the total scheme expenditure. These excluded doctor and allied services while a patient was in-hospital.

The increase in the use of day hospitals

Internationally there is a trend in increased day surgery for multiple reasons including:

  • Improved anaesthesia (with quicker recovery period)
  • Improved pain control (anaesthetic blocks and improved medication)
  • Instrumentation and procedures (keyhole surgery).

Cost saving initiatives

Private medical aids are struggling to keep up with rising healthcare costs, which usually outpace inflation by 3+%. They are continually looking for ways of reducing costs and keeping premium increases as low as possible without prejudicing the quality of healthcare or financial stability of the fund.

We negotiate special rates through our hospital networks and designated service providers (DSPs) and encouraging members to use managed care initiatives. Encouraging members to use day hospitals is another way in which we can save on costs. That said, the strategy amongst acute hospitals is to reduce the tariffs for day surgery to the level of day clinics to prevent a market shift away from their facilities.
Examples of price differences

Other advantages of day hospitals

  • Patient satisfaction
  • No overnight stay – patients are admitted, operated on and discharged on the same day
  • Child-friendly wards and facilities – day hospitals are the ideal alternative for children requiring same day surgery as the trauma of overnight stays are eliminated

    • ,li>Lower risk of infection – due to the fact that patients return home on the same day, the risks of cross infection are reduced, which results in a shorter recovery

  • Mortality and major morbidity is extremely low (1%)
  • Improved surgery scheduling – decrease in waiting lists

Why is take up not higher?

  • Day hospitals clearly have marked advantages but the reason take-up is not that high, is there are some perceived disadvantages of using them. One which is the geographical access – specifically in areas like the Eastern Cape.
  • There is concern around procedure complications and the need for a patient to have advanced care. But legislation is strict around day hospitals and they have to be located within five kilometres of an acute hospital for exactly this reason.
  • The issue of doctor access is another factor inhibiting the rapid increase in use. Many doctors have their consulting rooms close to an acute hospital and are unwilling to travel further. Equipment may be limited in day hospitals but the increasing list of procedures which can be performed in day hospitals speaks to this challenge being overcome.

This is probably why the percentage of day cases, split between acute hospitals and day hospitals, is still biased toward acute hospitals. Currently the split of day cases being done in acute hospitals is 74% and 26% in day hospitals. This implies that 74% of all procedures which could be performed in a day hospital are currently performed in acute facilities.

Safety is foremost

Not all patients can go to day hospitals. It should be noted that this percentage will be lower as some patients would have anaesthetic and comorbidity risks and from a safety perspective may rather have the procedure performed in an acute hospital where overnight facilities are available. Additionally, not all day clinics are adequately equipped to do some procedures and, as such, the true percentage will be lower.

Will day hospital use be enforced?

The Day Hospital Association of South Africa has proposed that medical aids enforce day hospital use in the future but also caution that there are some cases which cannot be carried out in day hospitals.

There are some procedures for which this is not suitable. High risk patients who require more intensive post-surgery care would require acute/conventional hospitals. But the benefits of day hospitals should definitely be considered by all patients when undergoing a procedure.

The South African health system after Covid-19

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Health systems in countries such as South Africa are invariably characterised by a mix of public authorities with wider social obligations and private arrangements, such as insurance and service provision, responsive to individual demand and need.

Professor Alex van den Heever, chair, Social Security Systems Administration and Management Studies at the Wits School of Governance.

Getting the public and private sectors to serve the public interest depends on the conscious organisation of the health system by the state. Naïve policy debates however tend to fixate on simplistic distinctions between public sectors, assumed to be virtuous by nature, and private sectors, assumed to be driven exclusively by transactional values.

For a considerable time in South Africa it has been evident that public authorities do not naturally act in the public interest. Far from being inherently virtuous, they are highly susceptible to capture by private interests where institutional designs fail to avoid this possibility. A poorly designed public health system will reflect the worst of all worlds. It will serve private interests without any of the benefits of a private market.

However, in the absence of a well-designed regulatory framework, private systems will also fall short of the achievement of wider social goals. Unregulated private health markets suffer from market failures that remove many of the positive outcomes markets can deliver. Three deviations from competitive markets serve as explanation.

First, the need for health insurance interrupts the relationship between household budget constraints and the cost of healthcare services leading to supplier-induced demand.

Second, market-related incentives do not exist to offer relevant information on the quality of health services to users, thereby removing product quality as a basis for informed consumer choice.

Third, health insurance product complexity impairs the ability of consumers to make informed decisions about their choice of insurer, perverting the incentives for efficient healthcare service purchasing.

As noted by the Health Market Inquiry the South African private health system reflects all the expected outcomes arising from the failure of government to regulate for the above well-understood weaknesses.

Despite these market failures the private health system has important features useful to any future organisation of the health system. First, it has substantial assets in the form of facilities equipment and a relatively well organised and trained workforce. Second, it has capable organisations and institutions that contribute towards its resilience and adaptability as a sector.

So, what did the pandemic reveal about the South African health system?

First, the public health system has fewer critical care beds than the private sector, despite having more overall beds. This is largely due to the closure of hospital-based services in the public sector from 1994 to the present in the absence of any national public hospital strategy. Remarkably, in March 2020 the public sector did not even have an inventory of public and private facilities despite running all public facilities and licensing all private facilities.

Furthermore, apart from the Western Cape, the public hospital system was not even able to report on Covid-19 hospital activities to the National Institute of Communicable Diseases (NICD). The private health system however reported all Covid-19 hospital activities to the NICD from 1 April 2020. According to the NICD the private hospital system also treated more Covid-19 patients than the public health system.

If the excess death information reported by the South African Medical Research Council accurately reflects Covid-19 deaths, then thousands of public sector patients were either not treated or not reported. Irrespective, were it not for the substantial capabilities of the private hospital system all the private patients would have required accommodation in the plainly fragile public hospital system.

Second, operating through the centralised state laboratory services the public health system at no point exceeded the Covid-19 testing capacity of the private health system. The public system was also apparently unable to implement a coordinated testing and tracing strategy that utilised the combined capabilities of the public and private sectors. Testing and tracing therefore never formed part of a strategy to suppress transmission at times when prevalence was low.

Third, the rampant corruption in the procurement of Covid-19 supplies by provincial governments derives from the patronage-based governance design of the public health system where posts and tenders are exchanged for political advancement and kick-backs. Patronage-based systems occur where political office-bearers are able to capture the appointment, procurement and licensing decisions of public organisations. In South Africa this has led to the collapse of performance at all levels of government.

The pandemic has therefore revealed nothing surprising about the South African health system. The failure to regulate either the public or private systems properly is arguably causally related to the patronage model of governance that has depleted the capabilities of the state. Unfortunately, all evidence suggests that for the foreseeable future no meaningful reform of the health system will occur aside from populist rhetoric about the un-implementable National Health Insurance.

#BestofBiz 2020: Healthcare

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What a year 2020 has been! So, we’ve curated the year’s most popular articles, most-read contributors and brand press offices with the most views on Bizcommunity’s Healthcare platform into our #BestofBiz2020 list, to give you a comprehensive perspective on what’s happened.

Our most-read stories

Our most-viewed press offices

Our most-read new appointments

View the most-read lists for our other industries: Marketing & Media, Retail, Agriculture, Automotive, Construction, CSI & Sustainability, Education, Energy & Mining, Entrepreneurship, Finance, Healthcare, HR & Management, ICT, Legal, Lifestyle, Logistics & Transport, Property and Tourism.

Don’t miss BizTrends2021 – 8 keynote speakers forecast trends shaping business in our region! Register now!

Bloom Financial Services endorses Universal Health Coverage Day

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What is Universal Health Coverage Day?

Universal Health Coverage Day aims to raise awareness about the need for health services, which includes prevention, promotion, treatment, rehabilitation and palliative care for all people without the risk of undue financial hardship when trying to access such healthcare. The campaign seeks to rally support and action by government and role-players for better health coverage across the world by 2030. To this end, advocates of the movement share the stories of millions of people who are desperately in need of quality healthcare. Says Secretary-General of the United Nations, Antonio Guterres, “Universal health coverage is integral to delivering Sustainable Development Goals, our blueprint of a better future for people and planet. On this International Day, let us reaffirm our commitment to health for all as an investment in humanity, wellbeing and prosperity for everyone.”

More South Africans are choosing health insurance for affordable healthcare

According to a report by Statistica, in 2018, 16.4% of South Africans were covered by a medical aid scheme. For many cash-strapped South Africans, given the current economic hardships faced in the country, medical aid remains an unaffordable luxury. However, there is a solution for quality healthcare in the form of health insurance, which has seen more people from the lower income bracket selecting this cost-effective option to ensure they are covered for comprehensive health insurance covering basic medical, specialist and in-hospital benefits.

Health insurance is a relatively new concept in the country and is proving to be an alternative to medical aid. It covers a list of preselected benefits with a monetary value attached to each of these. It’s best for day-to-day medical expenses, which are serviced through its network of approved suppliers, and also provides limited hospital cover. The policies even cover death and funeral cover.

About Bloom Financial Services, trusted Momentum partner

Bloom Financial Services, a health insurance broker, was launched this year and has partnered with Momentum’s Health4Me. The company is committed to improving the lives of South Africans through health and aims to make private healthcare more accessible and affordable to its policyholders by offering medical insurance policies.

Says Bloom Managing Director, John Kruger, “Improving the lives of our customers is an ambitious goal that cannot be achieved without the right partner, which is why we chose to partner with Momentum to deliver the Health4Me healthcare solution. We fully endorse the United Nations’ Universal Health Coverage Day and support the goal of developing quality healthcare solutions for our citizens with a goal to have more South Africans with healthcare cover by 2030.”

The World Health Organisation (WHO) states that one of the key factors needed for universal health coverage is affordability. This means that a system is needed for financing health services so that people do not suffer undue financial hardship when trying to pay for or access quality healthcare services. The WHO goes on to state that “universal health coverage forms a critical component for a country’s sustainable development and poverty reduction, a key element to reducing social inequality.” While universal health coverage cannot be achieved overnight, the United Nations and the WHO urge countries to take the steps necessary to achieving this goal in the future.

Momentum Health4Me – the affordable healthcare solution

Momentum’s Health4Me is an affordable healthcare solution for individuals and families. It offers value for money and is very reliable, having its roots in Momentum’s extensive experience and knowledge of the South African healthcare industry and with a strong network of expert providers. Bloom has also partnered with Baby Yum Yum, one of the Number One Parenting Portals in South African, which is a multi-dimensional platform created to provide support, assistance and learnings to new moms and parents.

For more information about Bloom Financial Services’ Health4Me healthcare options, visit their website at www.mybloom.co.za; and for more information about how you can help with Universal Health Coverage Day, visit their dedicated page at: universalhealthcoverageday.org.

Revenue management and analytics can drive better healthcare

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Hospitals in Africa face several constraints. From a lack of infrastructure and resources to low access, a complex value chain, disconnected technologies and systems, unintegrated processes resulting in revenue leakage, late payment, stranded claims, uncollectible write-offs, as well as dissatisfied customers. Now with the added pressure of dealing with a pandemic, there is a lot more to consider in the everyday quest to help save lives.

Tharina Gombault, private health lead, Accenture in Africa

Patient flow

The movement of patients through a medical centre needs to be well managed or it can result in long waiting times, increased length of stay, and adverse health outcomes. The Covid-19 pandemic highlights the challenge as hospital networks experience a simultaneous surge in demand and a reduction in volumes of elective surgeries. Getting patients to the best place or unit at the right time for their condition across all current and incoming patients is no easy task.

Fortunately, as advanced, targeted solutions become increasingly affordable and accessible, healthcare providers have the opportunity to rethink their strategies.

Transformation to intelligent operations

Our research finds that the use of intelligent operations allows healthcare providers to refine back-office processes and activities, make the customer experience frictionless and increase profitability and customer retention while leveraging human resources more effectively. The move to intelligent operations is possible through applied intelligence – the combination of data with the power of automation, analytics and artificial intelligence (AI) at scale. This way, healthcare providers can rapidly achieve efficiencies and next-level performance.In practice, this means claims management will be more streamlined. A digital claims-monitoring tool can identify claims stranded with medical aid schemes, provide a timely alert, raise late payment charges, and automate follow-ups. An AI system can also make a prior authorisation for a procedure more efficient by validating the information associated with the request and thus freeing human resources to focus on higher-value tasks. Lastly, AI tools can simplify clinical coding, reduce claim denials and under-recovery of revenue by adding AI and automation to clinical document review.

At the core of this success is the effective use of data. With accurate data on length of stay, occupancy, patient experience, and financial risk, hospitals can enhance the prediction of patient flow to optimise hospital resources. Hospitals can improve operational planning and execution; enhance patient, doctor and staff experiences; and improve clinical outcomes.

Next-level healthcare performance

Africa’s healthcare providers need to solve for an outcome – they have to work with what they have now while preparing for what they want to do next.

Immediate steps to take include:

  • Accurate data collection
  • Capture data insights through visual dashboards
  • Train staff members to seek insight and make data-driven decisions to target value
  • Prioritise efforts – focus on near-term opportunities and sustained solutions based on value

After this, it is important to implement the right type of automation. If the work is transactional and rules-based, it is well-suited to robotic process automation (RPA), and if it is knowledge-based, then it’s a job for AI. Next, they can find and make use of AI and analytics solutions that can be delivered cost-effectively via the cloud. Ultimately providers can refocus and upskill revenue cycle resources.

In dealing with overcrowding or improving patient flow, healthcare providers should explore the data on key metrics across multiple dimensions. For example, monitoring data on admissions and excess days per unit, physician and service line, can help with understanding the opportunity cost of inefficiencies. Next, they should create data-centric operations where staff embrace the power of data and use it effectively to work smarter. This in turn leads to the start of a culture shift where staff can be educated, upskilled and exposed to technology and data tools to remove fear. It is important to focus on areas for ongoing analytics such as the optimisation of bed allocation, or occupancy and discharge prediction to build agile operations.

Roadmap

Hospitals should then create a roadmap to becoming connected and cognitive. Leading hospitals are connecting the visibility of surgical flow, patient flow and staffing to provide better patient care and a better experience for staff and physicians.

In conclusion, healthcare providers need to find alternative, cost-effective ways of providing healthcare services, and the future of healthcare work is being driven by technological advances that improve sustainable care. Transforming processes to intelligent operations through Applied Intelligence helps healthcare workers direct their focus on patient care rather than administrative tasks, thus improve hospital efficiency. Using healthcare analytics and exploring the use of data, can help with better revenue cycle management and improve patient flow. By handing over some tasks to machines, healthcare providers can optimise human performance and free up healthcare workers to do more important work in personal patient care.

Can mobile technology ‘vaccinate’ SA’s private healthcare industry against Covid-19?

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The Covid-19 pandemic has had a unique and substantial impact on the local and global private healthcare industry. As the numbers of Covid-19 cases continue to rise, the private healthcare industry finds itself at the centre of the pandemic, having to continue providing existing healthcare services, whilst also accommodating growing numbers of Covid-19 cases. As a result, the adoption of mobile healthcare technology by the industry is accelerating, as part of efforts to cope with increased demand, take care of crucial staff and maintain a high standard of patient care.


Insight Survey’s latest SA Private Healthcare Industry Landscape Report 2020, carefully unfolds the global and local private healthcare markets, based on the latest information and research. It examines South Africa’s burden of disease, latest SA trends and technology, private healthcare practitioner stats, hospital and clinic stats, medical aid and pharmaceutical sector trends, to present an objective insight into the South African Private Healthcare Industry environment and its future.

Although Covid-19 cases and deaths currently dominate the news, mortality rates have continued to decline annually in South Africa in recent years, with the number of registered deaths in 2017 reaching 446 544, a decrease of 5.1% when compared to 2016. Furthermore, similarly to the global trend, deaths due to Non-Communicable Diseases (NCDs) i.e. chronic diseases in South Africa continue to grow, with approximately 57.8% of deaths in 2017 being due to NCDs.

Despite these reductions in terms of the number of local registered deaths, the ongoing Covid-19 pandemic is likely to raise the numbers of overall registered deaths, as well as deaths due to communicable diseases in 2020. This presents both a challenge, in terms of capacity and demand, and an opportunity, in terms of demonstrating its effectiveness, to the local private healthcare industry. This is particularly relevant, as the spectre of the implementation of National Health Insurance (NHI) looms large over the industry, making it important for the sector to emphasise its value.

Key to the private healthcare sector’s response to Covid-19, has been the development and deployment of innovative mobile technologies. These technologies enable an enhanced standard of care to patients, that can be delivered in an efficient, safe and cost-effective manner. These technologies also contribute to healthcare practitioner wellness, whilst reducing costs to providers, such as medical aids and hospital groups, already experiencing financial strain.

As an example of the implementation of technology by the private healthcare sector in South Africa, artificial intelligence (AI) is being employed in the form of predictive data analytics, electronic health records and medication dispensing, amongst others. For example, Phulukisa Healthcare Solutions has developed a mobile clinic utilising an AI-powered cloud backpack, making it possible for specialists to test for deadly diseases in rural areas. Additionally, Radify is making use of AI to reduce the time required for the diagnosis of pneumonia in Covid-19 patients, in their Envisionit Deep AI diagnostics platform.

Moreover, local innovations designed to enable remote healthcare provision include a remote medication administration device, developed by researchers at the University of Cape Town and the Osmania University in India. This device remotely notifies healthcare professionals when a patient requires medication, allowing for the remote administration of the medication accordingly. Furthermore, in terms of monitoring, researchers at the University of Johannesburg (UJ), have developed a smart toolkit called e-mutakalo, which can monitor a patient’s health status and alert healthcare professionals when necessary.

The utilisation of mobile technology in the private healthcare sector is likely to continue to grow, as the industry adapts to the challenges posed by Covid-19, whilst also positioning private healthcare as a valuable contributor to South Africa’s overall healthcare environment.

The SA Private Healthcare Industry Landscape Report 2020 (158 pages) provides a dynamic synthesis of the global and SA private healthcare industry, from a uniquely holistic perspective, with detailed insights on: Global and SA burden of disease; latest global and SA healthcare trends and innovations; SA private healthcare practitioner statistics; SA private hospital and clinic stats, SA private hospital groups, SA medical aid sector and the SA pharmaceutical services sector.

Some key questions the report will help you to answer:

  • What are the major communicable and non-communicable causes of death, both globally and within South Africa?
  • What are the latest 2020 private healthcare practitioner, hospital and clinics stats?
  • What are the characteristics of the South African medical aid landscape, including trends and details of medical aid beneficiaries, medical aid schemes, administrators, major company profiles, and benefits paid by medical aids?
  • What are the characteristics of the South African hospitals and clinics landscape, including private healthcare facility statistics, and private healthcare hospital groups?
  • What is the 2020 SWOT (strengths, weaknesses, opportunities and threats) for the SA pharmaceutical services sector?

Please note that the 158-page report is available for purchase for R30,000 (excluding VAT). Alternatively, individual sections can be purchased for R12,500 (excluding VAT). For additional information simply contact us at az.oc.yevrusthgisni@ofni or directly on (021) 045-0202 or (010) 140- 5756.

For a full brochure please go to South African Private Healthcare Industry Report 2020

About Insight Survey:

Insight Survey is a South African B2B market research company with more than 13 years of heritage, focusing on business-to-business (B2B) and industry research to ensure smarter, more-profitable business decisions are made with reduced investment risk.

We offer B2B and industry research solutions to help you to successfully improve or expand your business, enter new markets, launch new products or better understand your internal or external environment.

Our bespoke competitive business intelligence research can help give you the edge in a global marketplace, empowering your business to overcome industry challenges quickly and effectively, and enabling you to realise your potential and achieve your vision.

From strategic overviews of your business’s competitive environment through to specific competitor profiles, our customised Competitive Intelligence Research is designed to meet your unique needs.

For more information, go to www.insightsurvey.co.za.

Making the most of current medical scheme rates

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With the majority of medical schemes now having announced their increases for 2021, it’s evident that these are the lowest increases the industry has seen for some time – much to the relief of consumers who are feeling the pressure of an economy severely impacted by the Covid-19 pandemic.

John Cranke. financial advisor, PSG Wealth Employee Benefits Midlands.

In the past, medical schemes have generally passed annual increases in the inflation plus 3% to 5% range, which would have meant total increases in the 6% to 8% range. However, increases for 2021 have generally been in the 4% to 6% range (with several schemes surprisingly announcing increases of even lower than 4%).

Although the Council for Medical Schemes in Circular 52 of 2020 (released on 23 July 2020) requested schemes to contain increases to National Treasury’s expected 2021 average CPI of 3.9%, demographic and utilisation factors will always prevail to ensure schemes can ensure financial sustainability, which is why several schemes have increases at a higher rate.

Lower increases

Understanding why the increases have been lower for so many schemes is simple. A lower demand for elective or non-urgent surgeries for a protracted period during 2020 has meant claims were substantially lower than budgeted for. In addition, some of the prohibitive lockdown measures also resulted in lower trauma-related claims. However, this has to be countered by the fact that testing and treatment for Covid-19 was added to the Prescribed Minimum Benefits (PMBs) early in May 2020. This meant that provided any medical scheme members followed the proposed treatment pathways, medical schemes were obliged to cover Covid-19 tests from risk, as opposed to day-to-day benefits, irrespective of whether a member tested positive or negative.The PMB guidelines were subsequently revised a couple of times, but the executive summary is that the guidelines set out what and how medical schemes must cover Covid-19 tests and treatment. By way of example, the PCR tests after referral by a healthcare professional are included at PMB level of care, but the rapid tests are not. The guidelines also cover what is not included at PMB level of care, such as the testing of employees retuning to work. If unsure about what is (or isn’t) covered, it’s best to confirm with your medical scheme.

Other factors that will come into play during 2021 are the pent-up demand for elective and non-urgent surgeries when lockdown restrictions are completely relaxed, and patients have the confidence to undergo the delayed procedures. A further expected impact will be the cost of providing cover for Covid-19 vaccines, and probably the largest and at this stage completely unknown factor, could be the cost of treatment for members during the expected resurgence (or second wave) of Covid-19. Medical schemes have therefore had to play a careful balancing act with the objective always being to protect their long-term financial sustainability.

The actual experience from scheme to scheme will also have been impacted by the underlying demographic and financial profile of the scheme. Medical schemes with younger age profiles or those in a robust financial position will in all likelihood be those with the lower increases for 2021, while the opposite will hold true for schemes with older member profiles or poorer financial positions.

Bizcommunity and NSP Consultants congratulate BizListing winners!

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Congratulations to the SME companies who have won full-page BizListing entries in Bizcommunity’s business directory.

There are still two BizListings up for grabs so click here to see if your SME is eligible to win! 
We are thrilled to announce that the applicants whose enterprises met all the requirements of the recent competition offered by donor Nishi Singh, MD of NSP Consultants, have been awarded to the following companies:

AGRICULTURE | Zele Business Enterprise

Pretoria-based agricultural supplier.

AUTOMOTIVE | Northside Panel and Paint

A Durban-based 100% B-BBEE female-owned company established in February 2015 by ole shareholder and director, Lerissa Naidoo.

AUTOMOTIVE | TLO Microfirm Auto-Repairs

A 100% black-owned company based in the rural village of Bloempoort in Limpopo. Trading in automotive repair and fitment as well a training center for the motor mechanics of the future.

BUSINESS SERVICES | Unathi Press

Print and office supplies specialists.

BUSINESS SERVICES | P Phillani Pty Ltd

A company that provides corporate catering solutions in the KZN region.

FINANCE & HR | Success By Design

A Cape Town-based outfit with 15 years experience in the banking, insurance, asset management and IT sectors, specialising in training and coaching people and businesses in a variety of disciplines, including design thinking, agile project management, process optimisation and more.

MARKETING & MEDIA | Typewrite Transcription and Typing Services

A Johannesburg-based company offering business services such as transcription, proofreading, typing and editing, for small businesses, students, government and corporates.

MARKETING & MEDIA | Whisper Media

A global service provider in content integration with a client base spanning Indonesia, India, South Africa, Singapore and Malaysia.

On behalf of the winning enterprises, Bizcommunity would like to thank NSP Consulting for their generous gesture in providing these small and medium enterprises with a chance to own a presence on SA’s indispensable business-to-business news website.

Thanks to everyone for entering and to the following companies, who were unfortunately not deemed eligible for full prizes, but who have each been awarded a discounted BizListing package.

Sika Creative Agency http://www.sikacreativeagency.co.za/

OWL HR   https://owlhr.co.za/

Honeycomb: https://honeycomb-bee.co.za/

Visit the new BizListing pages and enquire about the Special offer on a BizListing for your SME at moc.ytinummoczib@selas.