Sharon Gill
Choosing a healthy bottom line and attacting new members has seen medical schemes develop some innovative products in the past few years. “We really changed the rules of the game. We structured a wellness programme called Vitality, because if people lead a healthy lifestyle, it will lead to reduced healthcare costs,” says Neville Koopowitz, marketing director of Discovery Health.
“Discovery Health has forged partnerships with the Health & Racquet Club, WeighLess, Smoke Enders, Run/Walk for Life, and the Sports Science Institute of South Africa,” continues Koopowitz. “We wanted to break down the financial barriers and give our members access to health and lifestyle facilities which they may not have been able to afford otherwise.
“Our members earn fitness points for things like quitting smoking, reaching your goal weight, or taking preventative care of your health.
“Tests like pap smears and mammograms earn points because early detection of diseases sometimes saves lives and certainly saves costs.
“All our members have a fitness status. On
reaching each level you get instant access to a host of lifestyle and leisure facilities. For instance, on British Airways/Comair, a “blue” member can fly anywhere in South Africa for R575 return, a “gold” member will pay only R150 return. We’re rewarding healthy behaviour, and we’re filling an aircraft a day.”
“There are lots of products out there that are all smoke and mirrors,” says Gary Taylor, director of public affairs for Medscheme, the largest medical aid administrator in the country, “and sometimes, when it comes to paying for actual care, there’s an argument over liability. The package may look attractive, but at the end of the day you get what you pay for.”
With the majority of insurance schemes, 75c in every rand goes towards healthcare, the rest into broker commissions, marketing and insurance profits. Traditional medical aid societies spend 93c in every rand on healthcare and only 7c on administration.
“While the major thrust of traditional medical aid schemes is to provide real benefits,” continues Taylor, “there has also been a move towards wellness management. Medical schemes are offering incentives for people to stay healthy.”
Aid for Aids is an HIV management programme which is a co-operative effort between Medscheme’s clinical unit and the doctors of patients concerned. It is not just about throwing drugs at it. This programme offers state-of-the-art protocols to use with HIV management, which includes the dispensing of cocktails like AZT/3TC.
In the unenlightened 1980s, some medical aids refused to pay for treatment on the grounds that aids was a self-inflicted STD and therefore avoidable. They now acknowledge that this was avoiding the issue. Medscheme’s HIV management programme has been running very successfully for two years. A general practitioner sitting in the KwaZulu-Natal midlands can phone a medical professional directly and ask advice. Absolute patient confidentiality is guaranteed, and doctors appreciate that they’re being given some of the best protocols in the world.