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Brokers and advisers are crucial for industry sustainability

07 August 2024 Myra Knoesen

The healthcare industry is undergoing dynamic shifts, marked by both promising trends and emerging risks.

FAnews spoke to Lee Callakoppen, Principal Officer of Bonitas Medical Fund and the Board of Healthcare Funders (BHF) about the top trends shaping the healthcare sphere, the emerging risks impacting both the industry and medical schemes and the pragmatic approaches that can be employed to traverse these challenges.

The top trends

The three prominent trends in the healthcare environment, according to the BHF include:

  • A focus on sustainability:the industry is emphasising sustainability to address challenges in schemes, such as inflation and regulatory directives. The key is to ensure that measures taken enhance sustainability without unnecessarily burdening schemes.
  • Technological integration:increasing integration of technology, from telehealth solutions to data analytics, is transforming healthcare delivery and management,enhancing efficiency and patient care.
  • Patient-centric models:a growing shift towards patient-centric care models,prioritising individual needs and experiences, is influencing healthcare strategies and service delivery. 

Lifestyle diseases, according to Callakoppen, are considered a pandemic globally and South Africa is no different. “This is exacerbated by the decline in preventative screening including wellness checks and health risk assessments - which began during Covid. Preventative screening not only identifies pre-conditions and conditions, resulting in a better outcome for the patient but also helps contain healthcare costs, which benefits members of medical schemes.”

In the medical scheme space, he said, members are assessing the benefits and added value offered on the various medical scheme options and taking great care to choose the right medical scheme for their family’s healthcare needs. For this reason, he said medical schemes need to ensure that, despite premium increases, they can offer additional benefits to the members.

“Mental health is a local and international trend, not only because the topic has become less taboo but because the prevalence of mental illness is increasing at an exponential rate. Partly because during COVID members were not able to access normal medical care, however, in South Africa rising unemployment, load shedding and the general state of the economy have also contributed to mental health issues,” emphasised Callakoppen.

In the medical world, Callakoppen added that the use of Artificial Intelligence (AI) in healthcare and virtual or telemedicine is seeing rapid growth.

The top emerging risks

The risks, according to Callakoppen, include the continuing rising healthcare costs, the increased disease burden, the regulatory environment and the issues around the National Health Insurance (NHI). 

“Rising healthcare costs are not unique to South Africa, it’s a global issue. Healthcare advancements have extended life expectancy – people live longer, and this necessitates more extensive healthcare services and treatment. Mental health prevalence is also at an all-time high,” he said.

“As medical schemes, we need to enhance our disease management and care programmes and introduce better preventative measures to help reduce the onset of disease and improve outcomes,” said Callakoppen.

“We also cannot ignore the significant macro-economic challenges that are plaguing everyday South Africans. The increasing unemployment rate and reduction in household income, due to high bank lending rates, is creating significant barriers for South Africans to enter and remain in the private health sector,” he added.

The BHF added that some of the risks include leadership challenges (navigating uncertainties requires strong leadership, and potential disruptions in leadership can pose risks to the effective management of medical schemes), resilience amid challenges (adapting to unexpected challenges demands resilience, and medical schemes must remain focused on their primary mandate despite potential obstacles), and lastly, regulatory landscape shifts (changes in the regulatory environment, including policy shifts or new directives, can impact the operational landscape of medical schemes). 

Navigating these emerging risks

“To effectively navigate emerging risks, the healthcare industry and medical schemes should prioritise leadership (strong and adaptive leadership is essential to guide schemes through uncertainties and challenges), commit to the mandate (despite obstacles, staying committed to the primary mandate of caring for beneficiaries ensures a focus on the core mission), and lastly, build resilience (developing resilience as an organisational attribute helps medical schemes withstand and overcome unexpected challenges,” added the BHF. 

On the health front, Callakoppen said, “One thing we know for sure is that ‘prevention is better than cure’ and we need to encourage members to take better care of their health, to go for regular checks to prevent and manage disease. Lifestyle diseases are often due to lifestyle choices – this means we need to educate South Africans about the repercussions associated with risky behaviour. Managed care programmes will play a role in helping those who are battling with ill health, to stay on a wellness path.” 

NHI developments

Currently, Callakoppen said private healthcare provides for about 15% of the population so healthcare for all South Africans has been on the agenda for years. “From the outset, we have said we are not opposed to the introduction of NHI but believe that public and private healthcare can coexist. At this stage, we are monitoring the developments for the details around NHI – specifically in terms of how the Government proposes to pool public and private resources and what limit, if any, there will be for someone wanting to belong to a private medical scheme,” he said.

“That said, the BHF, South African Medical Association (SAMA) and the business community in South Africa have appealed to the Government to amend the current NHI model, as in its current form, it is not feasible,” he added.

Frustration voiced by members

According to Callakoppen, the most common frustration voiced by members is that they don’t understand the benefits and regulatory aspects of a medical scheme. He said there remains a misperception that medical scheme contributions cover all healthcare expenses and that medical schemes are obliged to pay for these in full. This is not always the case, and several factors must be taken into account. “We understand that navigating the medical scheme environment can be tricky, which is why independent advisers are invaluable,” he said.

“With rising healthcare costs and the increased burden of lifestyle diseases, it’s become critically important for South Africans to have access to quality healthcare and to understand what their medical schemes offer and how to use their benefits wisely. I envisage the role of the brokers being even more crucial as, and when NHI is introduced, to clear up any confusion in terms of what private medical schemes can offer,” concluded Callakoppen.

The BHF agreed, saying, brokers and advisers play a crucial role in ensuring the sustainability of the healthcare industry. It is essential for everyone to fulfil their responsibilities to meet the mandate of providing quality healthcare to beneficiaries amidst the industry challenges.

Writer’s thoughts

As we navigate the dynamic shifts in the healthcare industry, promising trends and emerging risks are shaping the landscape. The emphasis on sustainability, technological integration, and patient-centric care models are pivotal in transforming healthcare delivery and management, while addressing rising healthcare costs, increased disease burden, and a complex regulatory environment remains crucial. How are intermediaries effectively adapt their strategies to support the evolving healthcare landscape and address emerging risks while ensuring they continue to provide value and guidance to their clients? Please comment below, interact with us on Twitter at @fanews_online or email me - myra@fanews.co.za

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