Can Nutrition Be More Scientific?

By Gary Kantor. Mini-HTA #1 This is the first in a series of short articles about newer health technologies and their application. We call these “mini-HTAs” (HTA: Health Technology Assessment). We take a snapshot of new technologies, give a glimpse of the underlying science, and suggest how to evaluate the safety, effectiveness, cost, and impact. The science around nutrition has long been problematic. Published results go in all directions, some highly improbable (e.g. eat a handful of nuts each day and live 39% longer), with every nutrient (coffee, fat, alcohol, grain, gluten, fibre, you name it) associated in at least one study [...]

Unpacking the unintended consequences of the recent CMS Undesirable Business Practice Declaration

The recent CMS Undesirable Business Practice Declaration

By Craig Getz.   Unpacking the unintended consequences of the recent CMS Undesirable Business Practice Declaration In a recent Undesirable Business Practice Declaration published in Circular 24 of 2021 and gazetted in Government Gazette No 44469 on 23 April 2021, the Council for Medical Schemes announced that certain restrictions would apply to co-payments that medical schemes will be allowed to levy when a member voluntarily chooses not to make use of a network hospital, pharmacy or doctor. As Craig Getz explains in his blog post below, the consequences of this may not be in the best interest of medical scheme beneficiaries – [...]

long covid research

Patients can tell us more about the long-term effects of Covid-19.

By Gareth Kantor.   Most research has focused on the acute effects of Covid-19, including the devastating burden of severe disease, hospitalization and death that has resulted. But a significant number of patients experience a variety of long-term effects, troublesome symptoms that reduce quality of life, even after only a mild Covid-19 illness.  10-20% of Covid-19 patients report one or more persistent symptoms 2 months later1,2,3, an increasing concern for them, for clinicians and for health system administrators. This chronic illness has become known as “Long Covid” (LC). “Activist” patients4 have played an important role bringing it to public attention but [...]


Give patients a voice.

By Gareth Kantor.     In South Africa, “ask a friend” or a family member is often how we choose a doctor and judge a hospital. This is because we usually trust our friends and family, share personal values and appreciate their perspective. Is there a way to more systematically obtain and reliably distil the “wisdom of crowds” to assess health care?  Increasingly, the answer is yes. Although asking a friend isn’t always best, the measurement of patient experience and patient-reported outcomes is a valid method for assessing the performance of health care systems and is becoming the norm around the world.  Asking patients doesn’t [...]


Considerations on the new COVID variant.

By Craig Getz and Gareth Kantor South Africa is experiencing a second wave of the COVID-19 pandemic. In the last ten days, over 140,000 new cases and more than 4,000 COVID-19 related deaths have been reported. The second wave is believed to be driven by the so-called South African variant of SARS-CoV-2 (501.V2).  Concerns have been raised that the new variant spreads more rapidly and results in higher levels of morbidity and mortality including amongst the young who have been relatively insulated from severe disease. There are also questions as to whether vaccines, which have been shown to be effective in [...]

covid 19

Covid-19 conundrums and considerations.

By Insight Actuaries & Consultants Adapted from an article written for the SA Actuary magazine Written in June, published in July and updated for this blog dated 10 August 2020   The novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which is the causative agent of Coronavirus Disease 2019 (Covid-19) has been a pandemic of several kinds. First the epidemiological kind, as declared by the WHO on 11 March 2020, but also a pandemic of data visualisation dashboards, projection models, sensational news and strong opinions. It has been a polarising wedge in politics, society, and even the actuarial profession where we are not shy [...]


Global reactions to Covid-19, a brief overview.

By Insight Actuaries & Consultants As Covid-19 has spread around the world countries have adopted a wide range of varying mitigation policies for the pandemic. Country performance in dealing with the spread and resulting mortality from the disease varies widely, and so lessons can be learned from considering the different policy choices made. What seems clear is that acting early and strongly makes a difference, as does the ability to rapidly scale health system and surveillance capabilities. These short country specific discussions will be updated from time to time as the pandemic matures and more countries will be added for additional [...]


Medical scheme healthcare utilisation during lockdown.

By Craig Getz With the COVID-19 crisis looming, many are concerned by the likelihood of overwhelmed and overcrowded hospitals. This is of course a valid concern. For now, as at the time of publishing, the number of hospitalised COVID-19 patients remains low.  There has been a proliferation of models which predict hospital admission rates when the COVID-19 infection rate accelerates. There has though been very little focus on what is happening our hospitals right now.  COVID-19 and the interventions aimed at mitigating its impact have already had a dramatic effect on hospital admission rates. These effects can change the way medical schemes approach [...]


The Diagnostic Mortality Audit Process (DMAP)™

By Dr Gareth Kantor & Dr Michele Youngleson   No hospital in the world provides perfect care. We believe the best hospitals are those that strive continuously to improve and to make care safer. The management of a large client South African hospital embraced this challenge. They agreed to work with us to develop better systems for learning about, and improving, patient safety in their facility. Our initial focus was on preventable mortality using what we call a Diagnostic Mortality Audit Process (DMAP)™. The Stratification Matrix Not all deaths in hospital are unexpected. Many are the predictable outcome of serious illness and/or occur at the [...]


The Era of Behavioural Economics

By Barry Childs   2017 saw the Nobel prize in Economics awarded to Richard H. Thaler for his wide ranging work in the area of behavioural economics. While he is not the first to receive the award for work in this field, his writings and contribution to making behavioural economics more accessible have done us all a great service. We had the pleasure of hosting our third Foresight dialougues event a few weeks back with Behaviour as the theme. Topics included the impact of behaviour on fraud and fraud mitigation, what influences our medical scheme purchasing choices, addictive behaviour, anti-selective behaviour [...]