Medical Aids can prepare proactively for legislated changes

Medical Aid Schemes are currently experiencing high levels of uncertainty at present: major changes in healthcare legislation are in the offing which will directly affect their operations, and probably their profitability – but no-one knows what form these changes will take.

However, says Rajiv Ishwar, at The IQ Business Group, Medical Aid Schemes can take proactive steps now to prepare for the impending changes, whatever these might be.

“What we do know is that the changes will lead to an enormous new pool of people coming into a system that currently supports only about 7-million individuals. We also know that many of these new members won’t have the financial wherewithal of current members. And it’s likely that Schemes will receive less money for providing mandatory basic packages.

“This will put Medical Schemes under tremendous pressure, not only financially but also in terms of administration and patient management,” he says.

The challenge for Medical Schemes, Ishwar adds, will be to continue providing existing members with the same high level of services to which they have become accustomed – and making this available to the new membership pool.

Ishwar believes Medical Schemes must start now to prepare for the high volumes they will have to deal with once the new dispensation takes effect.

“Many Medical Schemes have invested considerable sums in developing IT infrastructure, but that’s only part of the story. They have to ensure that all their processes are effective, resilient and flexible,” he says.

According to Ishwar, Medical Schemes will also have to find innovative ways to train their own staff to deal with a far wider cross-section of members, many of whom will be utilising Medical Aid facilities for the first time.

“There is no doubt that recruiting, training and retaining individuals with the right level of skills could be one of the greatest challenges Medical Schemes could face,” he adds.

And in the face of uncertainties that lie ahead, the ability of Medical Schemes to effectively manage and monitor risk will be critical to their sustainability.

“Medical Schemes can wait until the new dispensation is in place – or they can take steps now to optimise their business processes in preparation. Even if the changes take several years to implement, optimising their processes now will put the scheme on a sound financial and operational footing to take on the challenges that lie ahead,” Ishwar concludes.