Lack of basic health literacy, an obstacle for medical aid users

Sibongile Mamafha, Principal Executive Officer at Thebemed Medical Scheme.

Many members of medical aid schemes do not gain the maximum benefits to which they are entitled—mostly because they lack basic health literacy, says Sibongile Mamafha, Principal Executive Officer at Thebemed Medical Scheme.

“Many of the users of medical aid often find themselves in this predicament partly due to unfamiliarity with how medical aid works. The first step in becoming health literate is learning to use the medical aid properly, just as you would do when buying a new smartphone,” she says. “The second step is to use the health information that your scheme supplies to you, in order to increase your general medical knowledge. An informed consumer is best positioned to make the right choices.”

For example, Mamafha says that many medical aid users find it difficult to access the treatment they need, and become frustrated. Thebemed’s experience has been that is can be attributed to members’ failing to follow the correct procedures. Typically, it is best to consult with the medical aid call centre first for advice and referrals before consulting your doctor. When it comes to consulting specialists, most medical aids insist on the patient obtaining an authorization to see the Specialist.

“These processes are in place for good reason, and have been designed to ensure that members get the right treatment,” Mamafha observes. “Our call centre staff is highly trained and can assist members in their own languages, making it easy to get real help. Read the literature your scheme provides to make sure you understand what services you are entitled to—and how to get them!”

When it comes to general health literacy, Mamafha notes that members often fail to take advantage of benefits to which they are entitled, and which have the potential to improve their quality of life over the long term. A prime example of this is failure to do the preventive screening tests which are provided for free. Preventive Screening is important because they provide vital early-warning signs and detect medical conditions like cancer, diabetes, HIV, early, to name just three. Our onsite health consultants are on hand to assist and answer questions. At the same time, a flu vaccine is offered, also for free. “Having these screening tests does not affect your day-to-day benefits and you shouldn’t have any out-of-pocket expenses” cautions Mamafha.

Regular screenings have tremendous benefits for members because they can detect health issues before they become dangerous—a huge bonus for members. And, adds Mamafha that companies should also play their role by working attendance into the working day.

Another issue for medical aids is that members often fail to adhere to the treatment regime prescribed by the medical professionals looking after them. Taking drugs at the wrong times or failing to complete a course of treatment, can reduce its effectiveness.

“Health is basically the foundation for a happy life. Being part of a medical aid gives one a real head start when it comes to improving it. If you are a medical aid member, take full advantage of this opportunity by becoming more health literate in every sense,” Mamafha concludes.