FANews
FANews
RELATED CATEGORIES
Category Healthcare
SUB CATEGORIES General  |  HIV |  Medical Schemes | 

Health quality measurement and reporting is healthy in South Africa

20 September 2013 Louis Botha, HQA.

“You cannot manage what you don’t measure”. “At least 50% of the medical scheme insured population in South Africa can feel satisfied that they are insured for their health care in an environment where Health Quality Measurement is taken seriously and where something is being done to improve the status of Health Quality on their behalf”, says Louis Botha, CEO of HQA.

On Tuesday 17th September 2013 HQA (Health Quality Assessment), a non-profit organisation, released the results of its 9th annual Health Quality Assessment Report. Fourteen medical schemes participated in the review and three years of clinical data representing more than 50% of medical scheme insured lives are included in the Report.

The following medical schemes should be commended for their voluntary participation in the 2013 HQA Clinical Quality Report: Bankmed, Bonitas, CAMAF, Discovery, Engen, Medihelp, Nedgroup, Netcare, Polmed, Remedi, Resohealth, Samwumed, Wooltru and Transmed. HQA is furthermore supported by the following member organisations: Agility GHS, Aspen Pharmacare, AstraZeneca, BHF, Carecross, CDE, Discovery Health, IMSA, Medscheme Health Risk Managers, Metropolitan Health Risk Solutions, Medipost, Momentum Health, MSD, MSO, Profmed, PMSA, SAMA, Sancreed, Servier, Sechaba, Sizwe and Universal Healthcare.

HQA’s members represent most spheres of the health care industry and collaborate on HQA’s CAB (Clinical Advisory Board) on an ongoing basis on the development of relevant health quality indicators.

Some of HQA’s measurements, for example, assess how much focus on prevention and screening there is and others assess the care received by people with common illnesses. HQA’s reporting mainly concentrates on process indicators with some simple outcome measurements. The aim is therefore to test the value of the healthcare members are receiving from their medical scheme. Participating medical schemes can therefore assess their performance in this regard, over time, relative to other participants and against international norms and standards (when available).

The results of the HQA Report can, for example, be used by medical scheme participants to consider: benefit improvements, rule amendments, managed care applications, provider/network contracting, member/provider education, system changes and/or to address problems with coding.

Whereas the HQA scheme specific reports are used by participants to assess, inter alia, the effectiveness of their benefit design, provider contracting, managed care strategies, member education and so on: the annual HQA Industry Report is used by the collaborative membership and stakeholders as a basis for healthy debate on Industry challenges. At this stage indications are that the Industry needs to find solutions for performing better in areas such as screening and prevention, management of certain chronic diseases and post-hospitalisation after-care.

HQA fully supports the Department of Health’s initiatives to improve clinical quality in the public sector and HQA also supports the Council for Medical Schemes’ drive towards improving health quality in the healthcare industry. As an independent, non-profit organisation HQA is ideally positioned to assist in that regard.

The HQA is endorsed by BHF, SANCU and the CMS.

For more information regarding HQA and the results of the 2013 Report, Louis Botha can be contacted on 0824535130 or at lj.botha@iafrica.com.

Quick Polls

QUESTION

South Africa’s economy is facing major policy and market challenges in 2025. As an adviser or broker, what concerns you the most?

ANSWER

Erosion of private property rights
Government interference in free trade
Inflation, administered prices
Weak growth, high debt
fanews magazine
FAnews February 2025 Get the latest issue of FAnews

This month's headlines

Unseen risks: insuring against the impact of AI gone wrong
Machine vs human: finding the balance
Is embedded insurance the end of traditional broker channels?
Client aspirations take centre stage as advisers rethink retirement planning
Maximise TFSA contributions before year-end
Subscribe now