Medical Aids

Flu shots on the go with Discovery Health and Uber

With winter and the dreaded flu season around the corner, Discovery Health has teamed up with Uber to provide flu shots on-demand.

For one day only, Wednesday 18 April 2018, riders in Johannesburg, Pretoria, Cape Town, Durban and Port Elizabeth will be able to request UberWellness on their app from 10:00 to 15:00, and will be met by a nurse who will administer a flu vaccine.

On the day, Discovery Health, Clicks and Dis-Chem have partnered to provide nurses who will be able to administer up to five individual vaccinations during one home or office visit. While the flu shots will be free, a once off charge of R100 will be charged directly to the rider’s Uber account to cover the cost of the home or office visit.

Discovery Vitality members will also earn 1,000 Vitality points for having their flu vaccine.

How it will work

  • Open your Uber app between 10:00 – 15:00 on Wednesday, 18 April.
  • Set your ‘pickup’ location.
  • Swipe right on your vehicle options to the UberWellness option.
  • Confirm your ride and if you are successful an accredited nurse will arrive to administer flu vaccinations for up to five people.

T&Cs apply

  • You must be 18 years or older to request.
  • The accredited nurse can administer up to five individual vaccinations at one visit, for a flat rate of R100.
  • Available in selected areas of Johannesburg, Pretoria, Cape Town, Durban and Port Elizabeth.
  • The vaccine will be at no cost to you: you will only pay R100 to cover the cost of the trip when you request through the Uber app.

On the day, demand will be high and as such riders are urged to be patient when requesting. Should riders be unable to request for the flu vaccination on the day, Discovery Health encourages riders to visit their closest healthcare provider or Clicks and Dis-Chem clinic to get their flu vaccination as soon as possible.

Putting the health citizen at the centre of UHC

As healthcare systems worldwide evolve towards universal health coverage (UHC), there must be a move beyond technical policy evidence to an action plan driven by participation, collaboration and implementation, where the overarching priority remains the person receiving the healthcare service

“If we can get that mindset right across the healthcare value chain, we will move closer to achieving UHC. We’ve heard a lot about why UHC would be impossible to implement, what we cannot do, and why we cannot do some of the things. It’s time the industry pushes boundaries to look at what is possible and what can be done to implement those pockets of possibilities without having to change regulations or legislation. It’s about identifying the low-hanging fruits and kick-starting practical steps towards UHC,” says Katlego Mothudi, managing director, Board of Healthcare Funders of Southern Africa (BHF).

Pockets of success

The narrative around introducing and implementing UHC in Southern Africa has always been that it is unaffordable, and that government systems are collapsing and are not geared to delivering UHC. Yet there are pockets of success in countries such as Rwanda, which ranks as one of the most successful UHC programmes in Africa. Lessons can be learned from Ethiopia and Ghana, which have also achieved significant milestones. These examples go to show that UHC for Southern Africa and for Africa is possible, he says.

“First we need to remove the barriers that we have created in our thinking about UHC. We need to look at what can be done now, without waiting for regulatory reform, and push the boundaries of what we have deemed impossible to realise workable solutions in delivering UHC.

Changing the relationship between the health citizen and service providers

“The healthcare sector’s priority should be ensuring that healthcare delivery is more member-centric and not service provider focused. Efforts must be made towards ensuring that the end product delivered to the health citizen meets their healthcare needs,” says Mothudi.

The relationship between healthcare service providers and the health citizen has conventionally been transactional. Even with chronic health citizens, healthcare service providers have built a relationship of dependence.

According to the BHF, there is a lot that medical schemes can do, working together with governments across the region, without having to wait for regulatory reform to begin driving the implementation of UHC.

Some of the current challenges include cost escalation, reduced access and poor or non-standard quality of care. For the insured, without a doubt, medical aid contributions required to purchase healthcare are very high, and out-of-pocket payments are increasingly becoming a big challenge to the health citizen. Benefits schedules are also so complex that members don’t know benefits to which they are entitled.

A common view among the insured is that while contributions are high, there aren’t enough benefits to justify the costs. For the uninsured, of concern across the region is adequate access to healthcare services as well as the quality of healthcare received. Across the board, health citizens do not know what to expect from their healthcare providers, and also don’t know how to measure quality care. As a result, they cannot benchmark to determine whether they are receiving the best available healthcare services or not.

Information and a multidisciplinary approach

“There needs to be adequate consultation and informed consent to empower the health citizen with appropriate information to influence their choices and compliance to the healthcare services provided to them.

“Information prioritisation must focus on empowering the health citizen; there is a need to create awareness of the drivers of costs, cost of services, to create an understanding of the impact of fraud on the health citizen, the impact of choice of care, as well as an understanding of treatment modalities.

Across the region and continent, there is inadequate accountability for the quality of healthcare. New technologies come into the country and into the region unvetted. There is a lack of standardisation of healthcare measures, which raises the question: whose interests does the healthcare sector seek to serve? If it is for the healthcare citizen, we would be more cautious about these things. A multidisciplinary approach to healthcare delivery and regulation alignment will enable a seamless implementation of universal healthcare across the continent.

“This can only be attained through industry collaboration with all the stakeholders in healthcare to truly deliver to the needs of the health citizen,” says Mothudi.

Putting the healthcare citizen first, pushing the boundaries of the possible is the theme of the upcoming 19th Annual Board of Healthcare Funders of Southern Africa Conference, which will be held at Sun City, from 17-20 June 2018.

Success in the fight against fraud, waste and abuse

‘Fraud, waste and abuse (FWA) in the healthcare industry is one of the main drivers of healthcare inflation and increased costs,’ says Kenneth Marion, Chief Operating Officer of Bonitas Medical Fund. ‘It’s a key focus area for us and we’re pleased to report that we’ve made great strides in the fight against fraud, waste and abuse. In fact our identification and confirmation of FWA has increased to over R129.8m in 2017 compared to R79m in 2016.’

The price healthcare pays

The local private healthcare industry spent over R150bn in 2016. Of this, a staggering
10%–15% of claims contained elements of fraudulent information – adding an estimated R22bn to the annual cost of private healthcare.

‘Over the years, we have observed an increasing trend in the abuse of the member’s benefits by certain medical service providers and fraudulent claims as a result of collusion between medical service providers and, in some instances, members of the Fund. This behaviour undermines the financial sustainability of the Fund and is detrimental to all of its members,’ Marion explains.

Who is affected?

Because a medical scheme is a non-for-profit organisation healthcare fraud, waste and abuse has a direct impact on the membership base.

Examples of FWA

Waste and abuse are far higher than fraud and more easily quantifiable in terms of values as it is usually a clear contravention of tariff codes or a rule that exists. The most common practices include:

  1. Billing for services not rendered (over billing).
  2. Using incorrect codes for services (at a higher tariff).
  3. Waiving of deductibles and/or co-payments.
  4. Billing for a non-covered service as a covered one.
  5. Unnecessary or false prescribing of drugs.
  6. Corruption due to kick- backs and bribery.

Combatting fraud

‘To minimise the impact of these common practices and to some extent address it, we have adopted a zero tolerance approach to FWA,’ says Marion.’ In 2015 we introduced an analytical software programme to identify anomalies or irregularities that could be indicative of FWA. The software is a robust solution that detects irregular claiming behaviour both for claim types and service providers.’

The successes

During 2017, Bonitas’s activities to detect and clamp down on FWA were amplified, with excellent results.

Total quantified value for interventions R129.8m (2017) R79m (2016)
Waste and Abuse Recoveries R35m (2017) R22m (2016)
Fraud recoveries R3,006,189 (2017) R2,096,381 (2016)
Total of recoveries R38m
Total paid by the Fund R47,05,686 (October 2017)
Decrease in claiming behaviour of identified healthcare providers R75m in 2017 (R31m 2016)

Bonitas investigated 35 cases of healthcare providers submitting fraudulent claims

These cases were reported to the South African Police Services (SAPS) and Specialised Commercial Crime Unit and criminal cases subsequently instituted. Five cases were finalised and all five healthcare providers were found guilty of fraud.

The sanctions applied include, but are not limited, to:

  • Laying criminal charges with SAPS against the perpetrators
  • Reporting the medical service providers to the relevant medical regulatory bodies
  • Application of section 59(2) and (3) of the Medical Schemes Act against the medical service providers;
  • Taking civil action against the perpetrator, and
  • Termination of membership where necessary.

Finding the culprits

The majority of healthcare providers implicated in the reported criminal cases are speech therapists and audiologists. Four of the convicted healthcare providers were medical technologists from Limpopo who submitted false claims for services which were never delivered. They were charged with 180 counts of fraud, made up of 21,171 claims. Bonitas is constantly engaging with the police and the crime unit to ensure progress on these cases.

Re-couping losses

One healthcare provider, practicing as a GP, was also found guilty of fraud after he pleaded guilty to the charges against him. This healthcare provider was also submitting claims to Bonitas members for services not rendered and using a locum that was not registered with the Healthcare Professions Council of South Africa. The provider was sentenced to five years imprisonment which was suspended and a fine of R185,000 payable to Bonitas by 31 January 2018. In addition, 52 healthcare providers were reported to Health Professionals Council of South Africa.

The punishment

Three of these providers are serving prison sentences of 9-10 years while one received a suspended sentence. Another provider is awaiting sentencing. The remaining 30 criminal cases are at various stages in court.

In 2017, Bonitas updated the forensic detection software to detect irregular claims at pharmacies as well. This resulted in:

  • A 40% increase in identified fraud, wastage and abuse
  • Recoveries increasing by 85%
  • A positive change in claiming patterns from healthcare providers a behavior change that amounted to R75m as of September 2017.

Recovering the money

Steps were taken to recover the money Bonitas paid out to these providers as a result of their fraudulent behaviour. Various measures were taken against healthcare providers who failed to honour the repayment terms. This includes internal controls introduced to identify healthcare providers who evaded the sanctions imposed, consequences of defaulting including being blacklisted.

The challenges

One of these challenges was a healthcare provider signing an acknowledgement of debt, agreeing on a pay back installment and then defaulting. A process was therefore initiated where the healthcare practitioner would be informed of consequences of not honouring the agreement which included them being blacklisted.

‘In some cases, blacklisted healthcare providers, who had their practice numbers barred by Bonitas, would simply acquire new practice numbers and come back to the system.’ says Marion. ‘This prompted us to introduce manual screening of all new practice numbers. This process has yielded positive results as 63 healthcare providers who were trying to circumvent the sanctions have been identified and blocked. We also introduced a process where a healthcare provider with an outstanding amount will be blacklisted in the credit bureaus.’

Zero tolerance

‘Based on our zero tolerance approach with regards to FWA, similar sanctions are being applied where medical service providers and/or members have been identified as having been involved. The sanctions are applied subject to the merits of each case,’ explains Marion.

‘This year we will continue to build on the criminal successes we have realised in 2017 and take further strides to conquer fraud, waste and abuse while constantly enhancing the working relationships with all stakeholders.’

Join the fight against fraud

Follow these tips to help combat fraud, waste and abuse.

  • Keep your personal medical scheme membership details (such as your membership number) private and your membership card safe
  • Check your medical aid statements to make sure that all claims are correct and for services you actually receive
  • Avoid any activities where you receive cash back for providing your membership details or other benefits that are not in line with the stated benefits on your option
  • Do not hesitate to query any irregularities relating to your claims with the call centre
  • Report any suspicions of fraud to our Fraud Hotline on 0800 112 811 – you can remain anonymous

Marion says, ‘We have systems in place to identify FWA within Bonitas but we also appeal to anyone who suspects any kind of wrongdoing to report it to their medical aid immediately.’

VAT increase won’t impact on medical aid contributions

There has been much debate around the 1% value-added tax (VAT), its impact on consumers and just how this will affect the money left in their pockets at the end of the month. With the revised general fuel levy, it’s clear that consumers will have to tighten their belts and adhere to stricter budgets.

The rising costs of healthcare

One area of concern is the cost of private medical aid and VAT. For years increasing healthcare inflation and economic pressures have been a challenge for the industry. “The reality is that when consumers are struggling, medical aid, which is essentially a grudge purchase, is often viewed as unaffordable,” says Gerhard van Emmenis, principal officer of Bonitas Medical Fund. “In addition healthcare costs are not regulated which is why it is crucial for medical aid schemes to continue to explore ways to contain costs without compromising the level of health care offered to members.”

Members’ contributions

However, he says, because the 1% increase will not impact monthly contributions or annual benefits. “Many members are confused as to whether VAT is payable on medical aid contributions but let me reassure you it is not,” says Van Emmenis. “The VAT increase will have no effect on members directly and what they pay every month. Medical aid contributions for 2018 are already. So, while the increase in VAT may influence the price of services, it will not impact benefits.”

“If your plan covers you at 100% of a scheme’s rate, you are still covered at 100% of that rate, no matter what the cost to the scheme because the scheme will absorb the VAT when paying for member’s benefits. The only impact is when it comes to savings and day-to-day benefits with members having a 1% lower buying power.”

The Council for Medical Schemes

In fact, changing contributions in the middle of the year can only be done with the permission of the Council for Medical Schemes following a request from the trustees of the medical scheme. This is a rare occurrence and most schemes generally put through contribution increases in January each year.

The law

VAT is never the property of any private entity but belongs to the government. “We are therefore only vendors that collect the monies on their behalf. From April 1, we will increase the VAT to all providers of the scheme by 1%. However, although this will have a direct impact on the budget for 2018 it will be absorbed by operational surpluses and not passed on to members.’

Tax credit

One positive announcement out of the budget speech regarding medical aid was around tax credits.

“Medical tax credits are effectively used as an ‘expense’ when calculating tax and reduces the amount of tax payable by a household belonging to a medical aid,” says Van Emmenis. ‘There are eight-million people who rely on these credits to make medical aid more affordable. Speculation was rife that the tax credit would be removed but it is a relief that private medical aid members have some reprieve.”

The bottom line: The 1% VAT increase and the additional 52 cents general fuel levy will have a knock-on effect for South African consumers, things will cost more. However, it will not affect monthly medical aid premiums or member benefits although it will have an indirect impact in terms of healthcare services being more expensive, which will reduce buying power.

Medical scheme claims expenditure far outstrips inflation

Annual medical scheme claims expenditure rose on average by 11.3% a year over the past decade, far faster than consumer price inflation, which increased on average by just 6.1%.

The Discovery Health Medical Scheme (DHMS) data came from its administrator, Discovery Health.

DHMS is the biggest open scheme in the country, with 2.7-million lives, and represents 31% of the total market.

The data highlight the financial strain facing many medical scheme members, who typically face annual hikes to their medical scheme premiums that outstrip their salary increases.

It is a problem that has vexed the Council for Medical Schemes for years and is among issues being scrutinised by the Competition Commission’s health market inquiry, which is expected to finalise its work later this year.

Discovery Health CEO Jonathan Broomberg said the data, packaged as the Discovery Health Medical Inflation Tracker, were intended to inform the debate about what was driving increased medical scheme expenditure. “In our view, if you are a member of a medical scheme this is a very accurate tracker of the way your expenditure has gone up.

“It represents 56% of the open market. Of course, at the margin there will be a scheme here or there that has an unusual [contribution] increase, but they are exceptional,” he said.

The tracker assumed benefits had remained constant in the period under review.

It unpacks the extent to which the annual increase in medical scheme claims has been driven by changes in the price of healthcare services, such as the fees for a consultation with a specialist or a night in hospital, and changes in the volume of services used by members, such as visits to GPs.

Between 2008 and 2017, the tariffs charged by healthcare providers such as doctors and hospitals closely tracked moves in the consumer price index (CPI). Tariffs rose on average by 0.5% above CPI during this period, at 6.6%. The use of services rose 4.7% a year because of increased demand for services from an ageing medical scheme population, a significant increase in the burden of chronic disease, changes to clinical practice and new technologies, drugs and hospitals.

The cost of treating breast cancer, for example, with chemotherapy, including the biological Herceptin, is about R335,000. Chemotherapy without the biological is about R39,000.

The tracker shows medical scheme claims inflation was 10.5% between 2016 and 2017, four percentage points higher than CPI, making it the lowest rate since 2011-12.

The key factor contributing to the lower increase was a drop in hospital admissions.

Both DHMS and the Government Employees Medical Scheme experienced a sharp rise in hospital admissions in 2015-16. Broomberg said DHMS had deployed case managers to hospitals where they had worked to get more patients treated as outpatients.

Empowerment deal for MetHealth, Thebe Health and Validate-Workerslife consortium

Metropolitan Health Group (MetHealth), Thebe Health Group, Workerslife Group (an affiliate of the PGC Group of Companies) and Validate (a group of healthcare industry players) have entered into a strategic partnership where Thebe Health and the Validate/Workerslife consortium will own a 49% stake in MetHealth.

MetHealth (a division within the health solutions environment of MMI Holdings Limited) administers the Government Employees Medical Scheme and provides wellness services to a number of clients, covering over 1.8-million lives. The key strategic focus of MetHealth is to achieve financial wellness for public sector communities by enabling and delivering sustainable integrated outcomes-based healthcare solutions as a transformed organisation.

Financed through a combination of equity and vendor finance, the transaction creates an exciting partnership which will empower a broad range of stakeholders including the Popcru Trust and Thebe Health’s broad base of shareholders and beneficiaries.

Collaboration

“MetHealth is pleased and excited about the prospects that this partnership creates. We look forward, not only to creating value for our partners and their stakeholders, but also to continue to deliver reliable, effective and quality healthcare services to current and prospective members. We believe that this transaction will help strengthen the MMI health business to become an even more significant player in providing greater access to quality healthcare in South Africa. Ultimately, this partnership demonstrates the parties’ commitment to the socio-economic development of a broader base of South Africa’s population,” Hannes Viljoen, CEO of the MMI health business, says.

Thebe Health is a subsidiary of the pioneering black-owned investment company Thebe Investment Corporation. “Thebe has always been looking for strategic partners to grow its presence in the provision of sustainable healthcare services. This transaction will serve to strengthen and embed Thebe’s presence in this critical sector of our economy. We are very excited about this partnership and we believe that it is merely the beginning of what will be a long and enduring relationship,” executive chairman Vusi Khanyile says.

“We are delighted with this deal, as it is yet another bold step towards the transformation of the healthcare sector, which promises to bring dignity to the lives of ordinary South Africans. This partnership is in line with the organisation’s commitment to providing short and long-term financial support to our clients, while ensuring sustainable growth and value for our shareholders,” Zwi Mdletshe, Workerslife CEO says,

“Validate is a hands-on and value adding partner in all the healthcare and related investments that we participate in. The deal presents us with an opportunity to become a significant player in the South African healthcare industry. It will also help address the transformation agenda. The consortium brings a wealth of experience, expertise and technology, to the partnership,” says Solly Motuba, lead for the Validate group.

Separate transaction

In a separate transaction, Thebe Health will become a 48% shareholder in a merged entity that comprises the mining-sector healthcare business of Providence Healthcare Risk Managers and Thebe Health. The Providence Healthcare Group, acquired by MetHealth in 2013, delivers administration and managed care services for restricted membership schemes. The merged business will be called Momentum Thebe Ya Bophelo and will manage the healthcare costs for over 120,000 employees on behalf of a number of blue-chip mining houses across the sector.

“Quality healthcare forms an important component to financial wellness and we are committed to delivering this to our people, their business and their communities; it will be a privilege to walk this path with our new partners,” concludes Viljoen.

The R256bn question: Where is NHI going to get its money from?

The idea behind National Health Insurance (NHI) is that it will operate as a single publicly financed and administered fund to which all South Africans will make compulsory contributions, based on their ability to pay. It would therefore promote cross-subsidisation on a bigger scale than is currently the case with individual medical aid schemes.

“The intention behind the NHI is said to provide free access to healthcare at the point of service for all South Africans and legal residents,” says Christel van Wyk, South African Institute of Chartered Accountants (Saica) project director: tax. “The primary long-term objective is to provide access to healthcare based on individual need, instead of financial ability, and to cover unplanned health events for everyone.”

The 2018/19 Budget outlines a number of transitional arrangements, although not as many as was originally anticipated in the run up to the speech.

Medical tax credits

In the meantime, whilst the plans for implementing the NHI are being streamlined, taxpayers have for the past few years been given some benefit in the form of medical tax credits, which have been the topic of much controversy in itself. This takes the form of rebate and has provided some tax relief for defraying expensive medical costs. It was always known that this would be an interim measure until such time that the NHI is fully operational, but there have even been talks of a complete scrapping of this rebate in the months before leading up to the Budget, but there were no such drastic measures, which is somewhat of a relief for the moment.

It was noted in the Budget, in relation to these medical tax credits, that some individuals are excessively benefitting from the medical schemes contribution rebate, specifically where multiple taxpayers contribute toward the medical scheme or expenses of another person. The example used is where adult children jointly contribute to their elderly mother’s medical scheme and where each contributor currently enjoys a full rebate, although the joint cost is for a single beneficiary. The Budget proposes that in such cases the medical tax credit should also be apportioned between the various contributors.

Increase

The monthly medical scheme fees tax credit will, from 1 March 2018, be slightly increased from R303 to R310 per month for the first two beneficiaries. For each additional beneficiary, the increase will be from R204 to R209. It is important to note that these increases are by design below inflation, the purpose being that government has earmarked the additional revenue that will flow from the below inflationary rebate to contribute towards funding of the NHI.

The expected impact is additional revenue of R700m in 2018/19, R640m in 2019/20 and R586m in 2020/21, and these benefits are therefore projected over a three-year period. While this proposal is in line with the proposals made in the NHI White Paper released in June 2017, it seems that this will not have a significant impact on the NHI cost, given that the 2025 estimated cost is in the region of R256bn. In the 2017/18 Budget, the then Minister of Finance, Pravin Gordhan set aside R5.2bn for the NHI fund, which although much more than this year, is still not significant considering the overall funding need,” concludes Van Wyk.

The NHI is therefore still pretty much a work in progress and significantly more work needs to be done before it goes live.

The big four – know your numbers

‘South Africa is heading for a disaster if the number of people living with chronic lifestyle diseases does not change.’ That’s what both the Human Sciences Research Council (HSRC) and the Medical Research Council warned two years ago. The Council described the problem of these non-communicable diseases as an ’emerging epidemic’.

If you look at the exponential growth of chronic lifestyle diseases then it is not difficult to understand why Health Minister, Dr Aaron Motsoaledi, maintains chronic diseases such as hypertension and diabetes are putting a huge strain on the country’s health care system.

Obesity and being overweight are major risk factors for the development of chronic diseases.

Testing for lifestyle diseases such as diabetes and heart disease is essential in the face of a steadily deteriorating health status in our country. Gerhard Van Emmnenis, Principal Officer of Bonitas Medical Fund says, ‘Get tested, know your numbers and take action now!’

The Bonitas Clinical Team explain why you need to keep your finger on the pulse of your ‘big four’ wellness numbers and what they are.

1. Cholesterol

What is cholesterol?

It is a soft, waxy substance – one of the blood fats made naturally in the body. It helps to form cells, hormones and bile (that helps us digest food). Cholesterol is found mostly in animal products such as meat, cream and butter.

What is high cholesterol?

This is when you have too much ‘bad’ cholesterol in your blood. This, in turn, can cause narrowing and blockages of the arteries – the blood vessels that carry blood to your heart muscle and to other parts of your body. In time, the narrowing of the arteries to your heart can lead to a heart attack, while blockages in the arteries of your brain can cause a stroke.

The test

Called a fasting lipogram it measures the exact amount of different types of cholesterol you have.

Good to know

  • If your total cholesterol is greater than 5mmol/L on your fasting lipogram this indicates raised cholesterol
  • Your low density lipoprotein (LDL) – the ‘bad cholesterol’ – should not be greater than 3mmol/L. LDL causes the build-up of cholesterol in the arteries which means a greater chance of heart disease
  • High density lipoprotein (HDL), if less than 1.2mmol/L, means you don’t have enough good cholesterol which prevents build up in the arteries and transports cholesterol to the liver
  • If your triglycerides (fat stored in the body) are higher than 1.5mmol/l, this is also indicative of a possible cholesterol problem.

2. Weight and BMI

Your Body Mass Indicator (BMI) calculator checks if you’re at a healthy weight.

The test

You can calculate yours by:

  • Dividing your weight in kilograms (kg) by your height in metres (m)
  • Then dividing the answer by your height again to get your BMI.


Underweight less than 18.5
Normal weight 18.5 – 24.9
Overweight 25 – 29.9
Obese 30 or greater

3. Diabetes

What is diabetes?

Our bodies produce insulin all day – a hormone that creates energy by converting sugar, starches and other foods. Without insulin, cells cannot absorb sugar (glucose), which they need to produce energy. When there isn’t enough of this hormone in your body, or it’s not used as it should be, sugar (or ‘glucose’) can’t be moved to your other body cells to supply them with energy. This means that you have higher than normal blood-glucose levels, resulting in diabetes.There are two main types of diabetes: Type 1 and Type 2. They are different conditions but are both serious and need to be treated and managed properly.

  • Type 1 diabetes occurs when the pancreas stops producing insulin. It usually starts very quickly and in younger people. If you have Type 1 diabetes you need insulin injections to survive as well as having a carefully balanced food intake and exercise programme
  • Type 2 diabetes (formerly called adult-onset or non-insulin-dependent diabetes) occurs when the pancreas makes too little insulin or your body can’t use the insulin effectively. It usually develops in adulthood and is often caused by being overweight and not exercising. Approximately 85–90% of all people with diabetes have Type 2 and many people who have this condition are undiagnosed. This can result in serious damage to the delicate parts of the body and lead to blindness, heart attack\stroke, kidney failure, impotence and amputation so it’s vital to be checked.

The tests

Test 1: The Fasting blood glucose test – blood glucose is taken before you eat in the morning.

Normal 3.9 to 5.5 mmols/l
Prediabetic or Impaired Glucose Tolerance 5.6 to 7.0 mmol/l
Diabetic More than 7.0 mmol/l

Test 2: HbA1c test. The HbA1c levels determine your blood sugar control over time.

Normal Less than 6%
Prediabetic 6 – 6.4%
Diabetic 6.5% or more

4. Blood pressure

What is blood pressure?

Blood pressure is the pressure of blood in your arteries – the blood vessels that carry blood away from your heart.

The blood pressures numbers mean the following: The first (or top) number is your systolic blood pressure. It is the highest level your blood pressure reaches when your heart beats. The bottom figure is your diastolic blood pressure and is the lowest pressure exerted as your heart relaxes between beats.

What is high blood pressure?

High blood pressure or hypertension is when blood pressure stays elevated over time. Hypertension is often known as the “silent killer”, since nearly 33% of people who have it, don’t know it. The only way to know if you have high blood pressure is to have yours measured. 

Range
Normal 120/80 to 129/84
Upper end of Normal 130/85 to 139/89
Mild hypertension 140/90 to 159/99
Moderate hypertension 160/100 to 179/109
Severe hypertension More than 180/110

If your blood pressure is too high, it puts extra strain on your arteries (and your heart) and

if it’s not treated, hypertension can cause kidney failure, eye problems, heart disease and stroke.

Van Emmenis says, ‘When you consider that one in every three people in South African has high blood pressure and every eight minutes one South African has a heart attack, it makes sense that we have our blood pressure taken regularly either at your local pharmacy or clinic or when you visit your GP.’

He urges all South Africans to be proactive and take control of their health by getting regular wellness tests done. ‘Knowing your numbers will help you manage your health better and making sure your ‘big four’ are under control will go a long way to reducing the costs of healthcare.

‘This is why Bonitas offers all members an annual wellness screening which includes the big four tests. The check is paid for from risk so it won’t impact a members savings or day-to-day benefits. We strongly urge our members to make use of the benefit and take control of their health.’

Discovery offers aid in public health

Discovery CEO Adrian Gore says he would welcome the opportunity to partner with the government in scaling some of the insurer’s healthcare innovations across the public sector, at no financial benefit.

“There isn’t enough collaboration between the public and private sector. Hopefully under the new leadership, I think we can do a lot more,” Gore said
following the release of Discovery’s interim results.

SA’s National Health Insurance (NHI), still at an embryonic stage, seeks to improve the quality of healthcare available to poorer citizens who cannot afford private medical aid. But even in a developed market such as the UK, the National Health Service is facing considerable financial pressure, suggesting that the NHI will succeed only via partnerships between government, medical schemes and healthcare providers.

Discovery Health Medical Scheme is SA’s largest, boasting a 56% market share (2.78- million lives). Administrator Discovery Health manages more than 3.4-million lives.

Discovery’s intellectual property was “an incredible asset in terms of its ability to connect the dots” in the healthcare value chain and understand the drivers of cost and behaviour, Avior Capital Markets analyst Warwick Bam said.

“A lot of our systems, such as HealthID and Dr Connect, could be scaled across the public sector. Talking off the cuff, I would be supportive of us doing that for no return at all,” Gore said.

HealthID is an electronic record of a patient’s medical history. DrConnect provides online access to medical information, facilitating interactions between patients and doctors.

While the lack of trust between the public and private sector was a barrier, there was massive opportunity.

“We could be funding much more stuff, not just in health insurance but in healthcare delivery and training of doctors,” said Gore.

Founded in 1992, Discovery is today a business with a market value of R118bn.

For the six months to December, normalised operating profit rose 19% to R4bn on strong growth from established and new businesses.

Discovery’s emerging businesses, Discovery Insure, Vitality Group and Ping An Health, swung from a R130m loss in the previous comparable period to a R66m profit. It is the first time that all three posted profit.

The profitability of Discovery’s interest in Ping An Health, China’s fastest-growing health insurer, jumped 500% to R36m. The size of the China opportunity was probably larger than already high market expectations, but this would take time and possibly more capital to bring to fruition, said Kagiso Asset Management portfolio manager Justin Floor.

Discovery invested R352m, or 8% of profit, in new initiatives, including its bank and Vitality Invest in the UK.

As a business that invested almost all of its cash into new initiatives, Discovery had been “trying harder than before” to convince the market that its business was well managed and that cash flow was under control, said Bam. The assumptions baked into its numbers, although based on the group’s extensive data sets and dynamic risk- pricing, did require investors to “trust management”.

There was a lot of potential for Vitality partnerships in Latin America, said Gore.

Discovery’s share price, which leapt 62% in 2017, closed 3.13% up at R182.07.

#Budget2018: Medical aid credits stay, but NHI funding model still unclear

The approximately eight-million people in South Africa who rely on medical tax credits to subsidise the cost of existing medical aid schemes can breathe a sigh of relief. The speculation that Finance Minister, Malusi Gigaba, in his budget speech, would do away with benefit to fund National Health Insurance (NHI) was unfounded.

Although the government has progressed on the path towards introducing National Health Insurance (NHI), and has discussed certain tax aspects of the funding, the actual mechanism remains uncertain.

NHI – where it stands

NHI was first proposed in 2011. The objectives include providing improved access to quality health services for all South Africans, employed or unemployed, and to pool risks so that equity and social solidarity are achieved through a single fund. It is anticipated that NHI will be implemented in 2025. In the interim, the design of NHI needs to be finalised and the extra costs of between R75bn and R108bn per year must be funded. Minister Gigaba has announced that over the medium term, the NHI is allocated an additional R4.2bn, funded through an amendment to the medical expenses tax subsidy.

Medical tax credits not removed

When the revised White Paper on the NHI was released in July 2017, Health Minister, Aaron Motsoaledi, expressed the view that medical tax credits are “unfair” and should be removed. This was met with public outcry. A report by Econex found that without the medical tax credit, the poorest 1.9-million medical aid members would be forced out of medical funds because of the prohibitive cost.

However, in the Medium Term Budget Policy Statement of 25 October 2017, Gigaba again noted that government was considering changes to the design, targeting and value of the medical tax credit as part of the policy development process for the 2018 Budget.

National Treasury indicated that it would seek input from the Davis Tax Committee on the feasibility of proposals to adjust the medical tax credit to fund the NHI. The committee’s final report, published on 13 November 2017, was clear that: “The phasing-out of the medical tax credits can only happen once the NHI is fully operational. In addition, the needs of people with disabilities and the aged and the financial implications for such taxpayers would require special attention.”

Government has taken heed of the concerns of the public, and medical tax credits will not be removed. Instead. The plan is to split out medical tax credits to individual taxpayers (where multiple people contribute to the same medical aid), and to impose below-inflation increases in medical tax credit over the next three years, in a bid to help fund the rollout of the NHI.

Future personal tax increases to fund NHI?

Budget 2018 did not provide any further details concerning the longer term funding of NHI.

The revised White Paper on the NHI included funding proposals. Five tax scenarios were identified:

  • Scenario A
  • The introduction of a 1% payroll tax, a 1% surcharge on taxable income and a 1% increase in the VAT rate
  • Scenario B
  • A combination of a 2% payroll tax and a 2% surcharge on taxable income
  • Scenario C
  • A 2% surcharge on taxable income with a 1.5% increase in VAT Scenario D A 2% payroll tax with a 1.5% increase in VAT
  • Scenario E
  • A 4% surcharge on taxable income alone

Scenario B has been highlighted as the “most preferred option” for revenue generation, being a 2% payroll tax on employers and an extra 2% tax on individuals. In practice, employer costs are typically factored into the ‘total cost to company’ of employment, and then economically borne by the employee. For existing employment relationships, it could be anticipated that employee increases would be lower to compensate for the extra tax. Economically, the effective personal income tax rates would shift by 4%.

High-income individuals are still reeling from the 4% tax increase in 2017. NHI would mean a further effective 4% tax increase. However, the final Davis Tax Committee report on NHI, issued in November 2017, suggests that the funding proposed in the White Paper is inadequate, and that the personal income tax surcharge would need to be in excess of 6%, not 4%.

Since Budget 2018 was silent in this respect, the questions remain around the actual funding of the NHI.

NHI – way forward

According to the NHI Impact Assessment document, the years 2017/18 to 2020/21 form the second phase of NHI implementation. This phase will focus on the development of the NHI legislation, amendments to other, existing legislation, and the establishment of the NHI Fund. The third phase, in 2021/ 22 to 2025/ 26, is where NHI-specific taxpayers are supposed to be introduced.

As highlighted by the Davis Tax Committee, adequate engagement in relation to NHI is essential to prevent later resistance during implementation, as happened with the e-toll situation.

Budget 2018 avoided discussing longer term funding. However, significant concerns remain around the funding of NHI, and the nature of proposals of heavy future tax changes on already burdened individual taxpayers.