The need to develop models to deal with HIV/Aids

The manner in which the healthcare industry deals with Aids is the single most important issue facing the sector at this period in time.

This statement was made at the recently held fifth annual conference of the Board of Healthcare Funders which is proving to be the most critical in its history in terms of the vital issues being discussed.

Dr Izak Fourie, CEO of the Health Monitor Group, reminded delegates of the epidemic’s characteristics, particularly its exponential spread and its impact on economically active age groups.

“It is fairly predictable on a population basis so we can develop models and projections on which to make more informed decisions concerning coverage and benefits,” he said. “However, we should remember that in fact it constitutes three epidemics – the first, HIV, is now probably waning, the second, now in full flow, is Aids itself and the third is the socio-economic result, whose repercussions we are only just beginning to perceive.”

Actuarial reports to determine the progress of the disease to serve as a basis for medical scheme solutions are no longer good enough, Fourie stressed. “We need dynamic models with different scenarios and cost interventions and this we can now do. Initially we made certain assumptions but once we had a general picture, we have been introducing systematic data collection on factors such as disabilities and deaths so that we now have fully validated models which we can integrate into the way we manage business.”

The impact on medical schemes he continued, would include cost escalations, the collapse of cross subsidies as young and previously healthy people succumbed, the new disease patterns, the cost of special investigations, the cost of special investigations, the cost of high active antiretroviral therapy, increased hospitalisation and terminal care.

Fourie emphasised that the traditional one-year budget generally produced by medical schemes fell hopelessly short when projecting Aids costs. “We need a multi-year budget which has to be based on comprehensive information on all those factors which impact on the industry, since decisions made today could make or break a scheme in four or five years time,” he cautioned. “It is also important to remember that providing anti-retrovirals (ARVs), will have a positive impact on such issues as absenteeism, sick leave costs, lost productivity, recruitment and training, which enter into the preserve of the employer’s Aids plans – although the medical scheme is generally bearing the full costs. In other words, the costs and benefits of healthcare interventions stretch well beyond the health sector itself. We need to work towards an integration with employer/community-based programmes.”

Providing ARVS in the current fee-for-service environment, he believes, will be unaffordable. He advocates a comprehensive disease management programme but cautions against the vertical programme approach which tends to become inefficient and expensive.

“The Medical Schemes industry actually needs a unified roadmap to manage Aids, “he continued. “And the potential impact of the Risk Equalisation Fund must be added to this, since the original date used for those calculations contained little Aids information.

“We also need to consider the impact of the expansion of membership of medical schemes from the current seven million or so to the projected 14 million which the Social Health initiative will introduce.”

BHF, Fourie believes, is ideally placed to produce a well researched industry impact model. It can serve as a collection or repository of industry data, constantly updated, of invaluable assistance to the industry in developing solutions for managing Aids.  “Combining actuarial projections of prevalence, morbidity and mortality with disease management cost projections will help to create a reliable roadmap,” he stated,” which in turn will enable the industry to make informed decisions.”