Sizwe Hosmed on the road to recovery, stability and renewed focus on member benefits
The Curator of the Sizwe Hosmed Medical Scheme, Lebogane Mpakati is pleased to announce that substantial progress has been made towards long-term stability and financial sustainability of the Scheme.
Since her appointment as the curator, Mpakati has been managing the Scheme towards stabilising operations and access to healthcare facilities for members. The Scheme has engaged with service providers with the aim of resolving existing issues in its relationship following industry concerns and healthcare access restrictions for members in the past few months due to the Scheme’s financial position.
Mpakati says, “Within a few months after my appointment, the Scheme’s members are now able to access more healthcare services across most service providers. Most hospital groups have since reopened access to members, supported by more predictable claim payment cycles and strengthened engagements.”
Some of the hospital groups that have reopened their doors to the Scheme’s members include Netcare, Life Healthcare outlets, as well as Beacon Bay and at Lenmed’s La Verna, Kathu, Lenasia, and Randfontein, Busamed, Clinix facilities and at NHN through ARWYP, Emalahleni Private Hospital, Carewell Robertson, JMH Hospitals and Nongoma Private hospital among others.
Despite this improvement in the Scheme’s relationship with service providers, membership movements remain a critical focus for Sizwe Hosmed. This has been especially important following the expedited 19.15% contribution increase and service disruptions.
Even with the upcoming exit of members affiliated to the South African Local Government Association, the Scheme will still remain viable with non-SALGA members. This is still within viable operating levels but necessitates a stronger focus on rebuilding membership – a major focus in the next couple of months.
“Retention and recovery strategies have been prioritised to rebuild membership, supported by actuarial comparisons that show strong benefit and price competitiveness when compared to Schemes of the same size,” adds Mpakati.
As part of the Scheme’s accelerated recovery efforts, Sizwe Hosmed is prioritising membership retention, pivoted on competitive benefit offerings and improved price positioning. Positively, the Scheme has managed to stabilise claims processing times with Service Providers.
“We continue to increase focus on resolving aged enquiries to improve member experience and moderated payment runs. This will allow the Scheme to improve predictability and reduce unnecessary alarm.
“We are encouraged by the meaningful progress made in stabilising operations, rebuilding confidence, and executing on the strategic priorities that will secure Sizwe Hosmed’s future. We acknowledge the difficulties of the past few years, and we remain committed to correcting them with transparency and accountability,” says Mpakati.
Addressing Past Challenges and strategic shift
Corrective actions are underway, supported by recommendations from a KPMG forensic investigation, which noted that the decline in the Statutory Solvency Ratio resulted largely from a surge in claims in the first half of 2023.
The Scheme recognises that long-term sustainability requires attracting younger healthy members to boost sustainability. As part of current structural improvements, marketing responsibilities will be an urgent focus area for the Scheme.
Looking Ahead
As the Scheme moves into the new year, its core strategic priorities will be hinged on solvency improvement, rebuilding strategic stakeholder relationships, service excellence, governance enhancement, digital transformation and exploration of amalgamation opportunities with comparative Schemes with strong solvency ratio.
“We are committed to placing Sizwe Hosmed on a sustainable path underpinned by strong governance, transparency, and integrity. Our members have stood by us in both good and difficult times, and we are confident that better days lie ahead,” concluded Mpakati.
