Countries around the world that provide health care as a social benefit are struggling to meet increased demands on resources.
Dr Gareth Hayton, managing director of Risk Management at Dental Information Systems (Denis), Africa's leading dental funder, says the current situation in Canada is a case in point. "Studies show that health care funding in Canada is not sustainable," says Dr Hayton. "Spending on health in every Canadian province is growing faster than revenue. It is also growing faster than inflation and economic growth."
Neither increasing taxes nor reducing the health care offered will solve the problem. Other countries faced by the same dilemma have chosen alternative solutions such as:
* asking patients to make co-payments for public health services used;
* recommending that individuals pay privately or through private
insurance for certain types of healthcare;
* allowing medical service providers to charge additional fees directly to
patients above public health insurance reimbursement levels;
* or permitting private health providers to compete for the delivery of
publicly insured health services.
Dr Hayton suggests that South Africa should learn from the mistakes of other countries to ensure sustainability of our health funding. Denis was formed in 1996 providing a service to medical aid funds to ensure sustainability and affordability for their dental benefits.
"In a world of exponential growth in healthcare technology and diagnostics, not to mention drugs, it stands to reason that health insurance premiums will also have to escalate exponentially. Since this is not sustainable, other models of funding simply must be found," points out Dr Hayton.
He says dental insurance can only be sustainable if it covers dental health as opposed to dental lifestyle. "Dentistry as a whole is uninsurable, while essential treatment is insurable. Only dental professionals can make and administer this distinction.
"We are in the business of containing runaway expenditure, but in a way that continues to provide access to essential treatment for our members," says Dr Hayton, adding that the 1.3-million lives insured by South African medical aid funds using Denis receive substantial dental benefits.
"The reasons for this include design of benefits by professionals who understand dental health, strict enforcement of parameters, administration by powerful systems, close communication with dentists, and an ongoing education campaign for members."
Dr Hayton says Denis is looking at expanding outside Africa to market its unique benefit packages in countries that need to contain runaway costs in dental healthcare. He is confident that the Denis model, proven over a 10 year period locally, can do the same in other parts of the world.