While more and more South Africans are seeing the necessity for healthcare cover, Dr Reinder Nauta, Executive Chairperson of the National HealthCare Group said it is also becoming increasingly apparent that a blanket approach to cover is not best suited to the diverse and changing needs of the healthcare market in our country.
“Instead, a more modularised offering can address fundamental healthcare needs effectively, while dramatically reducing costs. This begins at a primary care level and forms the foundation of a solid healthcare framework in providing a realistic forerunner to the NHI,” he said.
NHI, brokers and medical schemes
“NHI is still very much in the planning stages and a great deal needs to be accomplished before it can be rolled out. It will take time to implement and the changes it brings about will unfold gradually. Brokers continue to look at affordability, products that deliver for clients and worthwhile commissions. Innovative, modular products that provide cost savings in the employer market are also gaining momentum fast,” he added.
What can South Africa learn from other countries? “The bottom line is that we are all facing similar challenges – information sharing and a collaborative approach to developing solutions certainly seems to be the best way forward, wherever one is situated globally,” he continued.
Patrick Lubbe, CEO of the National HealthCare Group added that, “It is evident, globally, that access to quality primary care service remains foremost, whilst there are increasing initiatives to move a larger proportion of tertiary care into the home environment, which points towards allocating more funding available to primary care priorities.”
Reaching into underserviced markets
For those who have not before had access to healthcare cover, such as students and low-income employees, the cost of belonging to a medical scheme has long been prohibitively expensive.
“There are, however, practical solutions available, such as an employer funded reimbursement account that consists of an administration fee-based model provided in partnership with an independent network of thousands of healthcare providers, including doctors, pharmacies and others,” said Dr Nauta.
“This solution can and does work in multiple industries, assiting employers to provide cover for the entire staff base. For many this is a significant and necessary shift from only seeing a few employees covered, to experiencing greater access across the board with the result of reduced absenteeism and much improved employee health and morale. There is an evolution taking place in the business model, maturing from a primary care management model to a more sophisticated risk-sharing model. Corporates now provide for a maximum monthly healthcare expense per employee on their own balance sheets. This has already been shown to be far more cost-effective, in some cases having saved as much as 40% when compared with traditional health insurance premiums,” he continued.
Joining forces in addressing a shared problem
“A robust, cost-efficient primary healthcare infrastructure is the foundation of a well-functioning healthcare system and a healthy economy. This is particularly important in the South African context where a high prevalence of communicable diseases and a growing tide of non-communicable diseases have been noted. This has been further exacerbated by the COVID-19 pandemic, which has irrevocably altered the lives of ordinary people the world over,” he added.
“The decision of the Health Professions Council of South Africa, last year to allow phone or video consultations with doctors and other practitioners during the COVID-19 crisis, has resulted in a flurry of online healthcare consultations, which has served the upper end of the South African healthcare market particularly well. Unfortunately, with the cost of telecommunications being prohibitively high in our country, many South Africans are still left out in the cold. This is where more affordable communications platforms, such as WhatsApp, which is used by 9 out of 10 internet users, can fulfil the desperate need for connectivity. Popular platforms such as these have afforded healthcare service providers the opportunity to provide more affordable and accessible services,” he said.
“Appropriate intervention at primary healthcare level can also assist in alleviating the burden of disease and will also reduce pressure on the taxpayer-funded healthcare system by bringing many more uninsured, employed individuals into the private healthcare fold,” emphasised Dr Nauta.
According to Dr Nauta, joining forces to bring practical solutions to bear, rather than working in isolation, is important for laying solid brickwork when it comes to paving the way for NHI. In addition to funders and various industry bodies, this also needs to include individuals such as financial advisers and general practitioners. These stakeholders have particular and detailed insight into what is needed within the underserviced markets. It is in pooling our shared knowledge that we can unlock the greatest potential in what has previously been unchartered territory.
Ultimately, he said, this comes down to ease of use in how healthcare funding products are packaged and what results they can deliver for the end user.
Brokers’ evolving roles
“Brokers must be included in the conversation around new product innovations, as they provide a particular kind of insight into what consumers need and can afford. There is a myriad of solutions, as yet undeveloped, to address the healthcare needs of the vast and diverse underserviced market. Leveraging brokers’ insights, as well as their reach, can only stand the industry in better stead as a whole,” stated Dr Nauta.
He concluded by saying that brokers should, “Ensure that all employed people have some form of cover. Covid has taught us many lessons in the perils of being reactive, including when it comes to our health and our economy. Access to quality healthcare cover is needed right now. No one can afford to wait and see what is coming next. For brokers, this is an opportunity.”
Writer’s thoughts
In South Africa, private and public health systems exist side by side. The public system serves the vast majority of the population but is underfunded and understaffed. The wealthiest of the population use the private system and are better served than the poor. Achieving effective low-cost healthcare is only possible if a number of challenges affecting the industry are tackled. Do you agree? Please comment below, interact with us on Twitter at @fanews_online or email me your thoughts myra@fanews.co.za
Comment on this post