Insights

The Signal Model: Throwing Light into Dark Corners

Murky territory Have you ever tried to compare the value-for-money that you get from two different medical scheme options? Whether you’re a consumer trying to choose an option, a broker advising clients or a technical marketing actuary, you will know that it is impossible to come to an objective conclusion by simply studying the benefit brochures.  Simply tallying which benefit option offers richer benefits is insufficient, particularly since you need to make a comparison on multiple benefits. The question that needs to be asked is “what is the value of those additional benefits and how does it compare to the [...]

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Why Actuaries Need “Street View”

I remember playing with Google Maps for the first time. It was startling to get a zoomed-out view of your neighbourhood, your city, your country. In business-school speak this is the view from 30 000 feet. And this is the view that being an actuary affords you. We have the ability to look at the patterns formed by data, to join the dots in unexpected ways, to rise above the detail. Working in healthcare this means thinking about questions like how to allocate resources across provinces, or figuring out ways of measuring healthcare quality, or using statistical methods to benchmark [...]

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It’s Complicated

The first round of public hearings held by the Health Market Inquiry during February and March of this year have, at the same time, been both fascinating and frustrating to watch. I certainly don’t envy the panel members. There is an enormous amount of information to process. This includes thousands of pages of written submissions, presentations and transcripts. It is the task of the inquiry to process all of this information, distil it down to the facts and then make recommendations. This is by no means an easy task: not all of the information provided by stakeholders is relevant to [...]

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Round one of the HMI: Interpreting X-rays

Shivani Ranchod 11 March 2016   The first round of public hearings for the Competition Commission Health Market Inquiry (HMI) wrap up today. For those of us who have been obsessively following the proceedings it will be a relief to have a break before the next round. As one commentator tweeted: “Spellbound”. It has been a fascinating series of presentations from across the private health sector: medical schemes, administrators, hospital groups, individual patients, brokers, regulators, policymakers and various practitioners groups. If you were to read the media reports the overwhelming sense you would get is of an industry in trouble. Unsurprisingly the media [...]

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Truvada: holy grail or poisoned chalice?

Guest post by Leigh Johnson On Tuesday, 8 December 2015, South Africa’s Medicines Control Council approved the use of Truvada for HIV prevention. Truvada, a combination of two antiretroviral agents, has been shown to be effective in preventing acquisition of HIV in people who take the drug regularly. It is one of two drugs commonly used in ‘pre-exposure prophylaxis’ (PrEP), which refers to HIV-negative people taking antiretroviral drugs prior to sex in order to reduce their risk of HIV infection (the other drug that is often used in PrEP is tenofovir alone). Here we consider a few of the key [...]

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Low Cost Benefit Options: Doomed from the beginning?

Andre Bellingan The medical schemes industry was taken aback when the Council for Medical Schemes retracted its framework for Low Cover Benefit Options (LCBOs) on 12 October 2015, barely a month after it had been published at the end of a consultative process.  It appears that this retraction was at the behest of the National Department of Health, which had received a number of submissions that objected to aspects of the LCBO framework.   The “mandatory minimum” package of benefits as well as the tests and treatments mandated by the LCBO framework was criticised by parties such as the South African Medical [...]

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The lights go out one by one

Shivani Ranchod I have an uncle in his seventies who says that ageing hasn’t been too bad. Luckily, he says, the lights go out one by one. What he means is that your capacity diminishes slowly – giving you time to adjust to each loss. It seems that I have been reading and thinking about ageing a lot lately. It started with Tracy Kidder’s book “Old Friends”. It’s a gentle exploration of the inhabitants of a nursing home: their friendships, tragedies and idiosyncratic journeys to arrive there. I found the book utterly depressing but could not put my finger on why. [...]

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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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