Transformation is not (just) an agenda item

Shivani Ranchod More than twenty years into South Africa’s democracy and we still struggle with what the notion of “transformation” means (never mind how to actually achieve transformation, a struggle on an entirely different scale). It is not entirely surprising given the nebulous and deeply personal nature of the issue. My understanding of transformation comes from my own sense of identity, and my own life experiences. I cannot speak for others, except perhaps to point out that which is clearly not transformation. Having a social responsibility committee where you delegate responsibility for transformation is not transformation. BEE is not transformation. [...]

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Conflict Or Collaboration

Conflict or collaboration – a choice that faces all stakeholders in the healthcare industry. In a sense, the BHF is one area of collaboration that already exists in the healthcare funding industry. To be sure there are many areas for potential conflict. There is a scarcity of resources in healthcare, and so market participants compete for their share. This is an unavoidable reality. What matters is how these shares of resources are allocated. There are many tensions to keep in balance, and many factors to consider – equity, efficiency and efficacy. Among the models for balancing these tensions are [...]

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Benefit Design

At the recent BHF conference we had an opportunity to talk about benefit design – an area that is top of mind for schemes at the moment as 2016 pricing is finalised and preparations are underway to take 2016 products to the market. During this time of year benefit design can feel like just a part of the annual pricing process – a means to an end, a box to be ticked. But in reality benefit design is fundamental to the existence of a medical scheme. Benefit design determines what goods and services are purchased and how rationing decisions are [...]

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Leadership And Accountability

The theme for the BHF conference 2015 was “shared accountability: partnering for success”. This theme, together with leadership, explicitly and implicitly dominated both the formal and informal conversations throughout the conference. The South African private health care industry is at a critical point in its story for several reasons some of which will be highlighted here and all of which point to the need for greater leadership and accountability. Firstly, there are several policy documents that have recently been released, are awaited, are nearing finalisation or are out for comment relating to inter-alia medical scheme regulation, National Health Insurance, demarcation, the [...]

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Efficiency Discounted Options: Will they save the industry?

Efficiency Discounted Options (or “EDOs”) offer an appealing value proposition to medical scheme members. In return for undertaking to make use of a network of healthcare providers you can pay less for the same benefits compared to the price on the option that allows you to visit any healthcare provider you choose. The logic underlying this is that the network of healthcare providers is more efficient and that the efficiency savings are passed along to members. The general consensus is that such an arrangement is desirable. To quote from the Council for Medical Schemes Annual Report 2013/2014: Benefit options with network [...]

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Supporting NHI in South Africa

This report reviews health system benefits policy and purchasing mechanisms in Chile to inform the development of National Health Insurance policy in South Africa. It has been prepared by R4D in consultation with South Africa’s National Treasury and with financial support from The Atlantic Philanthropies.

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Last Year of Life

The aim of this paper is to highlight the key methodological considerations in an investigation into the costs incurred by health insurers arising from the provision of benefits during the 12 months preceding a beneficiary’s death. A South African dataset is used to illustrate the suggested methodology. Download the paper to read more

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HASA – Intl utilisation benchmarking

This project was commissioned by the Hospital Association of South Africa (HASA). The aim of the project is to compare the hospital-inpatient admission rates and length of stay of the South African medical scheme population with a set of international comparators. Download the paper to read more

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Comparing the cost of hospitalisation across private and public sectors

The South African private healthcare industry faces significant changes in national health policy which most notably include the likely introduction of National Health Insurance (NHI). The possibility exists that the NHI agency will seek to contract with both public and private healthcare providers (referred to as plurality of provision). This raises questions of relative pricing between the two sectors. The concept of “price” from a consumer or funder perspective is complicated because services in the public sector are frequently not sold, and where prices do exist (for those above the means test) they are not determined by the existence [...]

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Why your organisation could benefit from an actuary

Imagine you are the CEO of a company. Let’s say your business is middle to large sized. It could even be a small business which has a decent customer base and is starting to gain traction in its industry. As any other type of business, you are either providing a service or selling a product. If it’s 2015 (which it is) and you have a strategic mind-set concerning your business (which we trust you do), you have probably harnessed the power of collecting information about your customers so that you can tailor your marketing to appropriately target your customers. If you [...]

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