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The future of healthcare: medical schemes need to do more to provide affordable cover

A steady increase in the uptake of affordable health insurance is an indication that there is a critical need for cost-effective and adaptable healthcare solutions.
Source: Supplied. Damian McHugh is an executive at Momentum Health Solutions.

As medical scheme providers, the onus is on us to find ways of providing affordable healthcare cover to millions of uninsured South Africans.

There is no doubt that the Covid-19 pandemic dealt our economy a heavy blow, with consumers still reeling from its impact. The Russia-Ukraine war, if it continues unabated, will have a ripple effect on developing economies, including ours. This will, in turn, add further strain on an already embattled consumer in the form of soaring inflation as well as rising oil and food prices.

The turbulent economic conditions we find ourselves in call for medical-scheme providers to relook and develop cost-effective and flexible healthcare solutions that will ensure that millions of South Africans who cannot afford medical aid gain access to quality and comprehensive private healthcare.

This need is evident in the number of people who are signing up for Momentum Health4Me, a cost-effective solution aimed at providing flexibility to consumers to pay for what they can afford and change between options as their needs and income evolve.

The steady increase in the uptake of Health4Me has, in fact, seen us report normalised headline earnings of R94m, a 9% increase from the previous reporting period.

According to a report, the public sector is State-funded and caters to the majority (71%) of the population, while the private sector is largely funded through individual contributions to medical-aid schemes or health insurance and serves around 27% of the population.

Affordability is critical if we are really going to shift the needle in terms of contributing towards making a real impact on the lives of millions of South Africans who must bear the brunt of inadequate services provided by public healthcare facilities because they have no medical aid.

While we fully support the initiative by government to introduce the National Health Insurance (NHI) as a mechanism to improve access to quality and comprehensive healthcare services for all South Africans, we believe that private healthcare providers also have a significant role to play.

In fact, it is our view that the implementation of this bold undertaking by government can only succeed if critical stakeholders in both the public and private healthcare sectors co-operate and commit to working together instead of against each other.

As the country’s healthcare landscape has been biased to favour the few that could afford access to the levels of professionalism, advanced technology, and equipment that is provided by the private sector, we acknowledge that the introduction of NHI is critical to the envisaged reform of our healthcare framework.

In our view, the NHI should cater for the unemployed, while private-sector players focus on providing low-cost health insurance for the employed but uninsured South Africans.

It is against this very backdrop that we designed Health4Me, which in essence eliminates wastage in the form of over-spending and under-utilisation for medical-aid members.

Medical-aid schemes are normally designed in a way that enables consumers to access more by buying up or paying for more, and in some instances, that translates into consumers paying for products and services they don’t necessarily need. Our solutions enable clients to pay for what they need and for what they can afford.

Additionally, some of our solutions go as far as unlocking cash for our members to use when they need it most by, among other things, earning funds to spend on additional medical expenses (by leading a healthy lifestyle).

Members also have the option of using their medical -savings accounts to pay their contributions when they find themselves in difficult financial conditions, for example, when financial shocks in the economy take place.

This frees up cash for members to use in other areas – for instance, on fuel or food. Ideally, medical aid should make provision for a measure of flexibility as a member’s circumstances change.

The devastating impact of Covid-19 across the globe, as medical personnel and facilities battled to provide the best care under the most difficult conditions, has underscored that health-insurance membership is not an optional “nice to have”.

The slow pace towards the finalisation and implementation of the proposed NHI means that, for the foreseeable future, individual South Africans will continue to have to make important decisions and choices about health cover to access quality healthcare.

Medical-scheme providers should be at the forefront of designing low-cost solutions that would contribute towards ensuring that all South Africans have access to quality and comprehensive private healthcare.

About Damian McHugh

Damian McHugh is an executive at Momentum Health Solutions.

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