The toll of a pandemic on healthcare costs and provisioning.
Adapting to a new way of enabling and delivering quality healthcare for members during an ongoing pandemic will be key in the approach of medical schemes in 2021.
According to Jacqui Nel, Business Unit Head of Healthcare at Aon South Africa, the industry has experienced a mixed bag of effects. One of the positive developments of the pandemic and the subsequent lockdown has been the industry’s ability to adapt to the new normal by swiftly embracing innovative diagnostic platforms. “The use of virtual care consultations with doctors and nurses has increased, as did the adoption of telemedicine,” explains Jacqui.
However, one of the more concerning trends noted by the industry is a marked decline of members going for important preventative care and screening testing, together with a sharp decline in elective surgeries. “Prevention is always better than cure, and the later a patient is diagnosed with a serious illness or condition, the more complex the health implications become, in addition to treatments becoming more costly and possibly more protracted. In the case of critical illnesses such as cancer, a delay in diagnosis and commencement of treatment greatly impacts prognosis and survival rates. The pandemic will continue for months, and for this reason we strongly recommend that members do not neglect their preventative health checks during this time,” says Jacqui.
Given the major financial challenges facing consumer households as a result of the lockdown, the affordability of maintaining medical scheme cover is another hurdle facing medical scheme members. The current economic challenges are set to continue well into 2021, and during this time it is vital to ensure that access to quality healthcare and cover are not compromised.
As financial pressures tighten, many medical scheme members are looking to change and downgrade their benefit options in a bid to save money. “Making the right decisions about the options selected within a medical scheme starts by understanding what benefits will be available and the affordability of the premium attached to these benefits,” says Jacqui.
“The Medical Scheme Act currently protects members within the realm of Prescribed Minimum Benefits (PMBs), which enforces cover for 270 diagnosis and treatments of a defined list of chronic conditions and emergency care, assuring members of this cover. The only precaution to take is to confirm whether the cover falls in the private or public-sector environment. Once that aspect is confirmed, a member can drill down to the day-to-day care offered in a medical scheme option and the subsequent affordability of it,” Jacqui explains.
By the middle of October most medical schemes would have announced their projected increases for 2021, together with benefit changes and new options. “We strongly recommend that you speak to your healthcare broker to examine your options in order for you to make an informed decision when it comes to finding an option that suits your specific needs and your pocket,” Jacqui concludes.