Medical costs will not diminish until abuse of medical benefits ends, reports Sharon Gill
`The medical scheme environment must not keep the sick and elderly out, but rather make sure we keep the young and healthy in,” says Neville Koopowitz, marketing director of Discovery Health.
“Schemes need to balance their risk profile in order to survive. Programmes like Vitality, our medical savings account structure, and our customer service, are geared to ensure we have happy clients who see their medical scheme as a lifestyle rather than a grudge purchase.”
Rob Slater, principal officer of National Medical Plan, sees achieving a healthy nation as the big challenge. “If lifestyles are healthy, it will have a positive impact on the country as a whole.”
According to Gary Taylor, director of public affairs for Medscheme, the biggest single challenge to the industry worldwide is healthcare inflation, which is between 16% and 20%. This is double the cost of living inflation rate. There are a number of causes for this.
Firstly, medical technology doesn’t come cheap. Complicated equipment and most drugs are purchased in pounds or dollars. MRI (magnetic resonance imaging) scanners and laser surgery are superb innovations but hugely expensive, both as a purchase and as service. (An X-ray costs just R300 while an MRI scan costs a hefty R3E000.)
One solution would be for the state to regulate the importation of specialised equipment.
Perhaps hospitals see MRI scanners as a status symbol, because everybody wants one. There are more MRI scanners in Johannesburg alone than in the whole of England.
On the drug side, some drugs have a 900% mark-up between manufacturer and consumer. Some locally manufactured drugs are being costed as if the raw materials were imported – this is called transfer pricing – leading to former minister of health Dr Nkosazana Zuma threatening the drug companies with parallel importation from the East.
A change in the Pharmacy Act could allow for a deregulation of the industry in the interests of lower costs to the consumer. At present, 30% of our total healthcare bill is spent on medicines, compared with the rest of the world’s 12% to 15%.
Secondly, we have relatively new diseases, like HIV/Aids, and we’re seeing more cases of old diseases like malaria and mental illness. Modern society produces more depression and stress-related illnesses, and treatment costs money.
Further aggravating the situation is our unhealthy modern lifestyles. We’ve processed and refined our food, we’ve invented some wonderful additives and interesting toxins and now we’re fiddling with nature by genetically engineering vegetables. We’re not yet entirely sure of the harmful effects, but we’re eating, drinking, and smoking the stuff anyway.
Contributional costs will never diminish until abuse of medical benefits is brought to an end. Fraud and outright theft is direct abuse, but indirect abuse is just as destructive. This includes over-servicing by doctors, for example those who provide medically unnecessary treatment; over- utilisation by patients (doctor-hopping or specialist-obsession like demanding a gynaecologist and paediatrician in attendance instead of one good old- fashioned midwife); and wastage (not completing a five-day course of antibiotics because you feel better after two days. Not only might you develop a resistance to that antibiotic, but the infection can recur).
“Prevention through education is the answer to all of this, with incentive programmes to make it worth your while to maintain a healthy lifestyle, says Taylor.
“The Medscheme Club magazine deals with subjects like how to manage asthma or diabetes, and the importance of things like dental check-ups and early-warning tests like pap smears.”
Medscheme is also proactive in trying to eliminate fraud within the industry, and in 1999 its fraud unit recovered R11,2-million.
Also a factor in healthcare inflation is our ageing population. People are living a lot longer than they used to. In sub-Saharan Africa, life expectancy has increased by nine years over the past 30 years.
In the space of one year, an older person will claim three times more from his medical aid than a younger person. You’ll still die, but you’ll go down in a blaze of glorious medical bills.
The only acceptable solution is to prioritise resources. Social engineering is not an official option, and the suggestion is contrary to the ethics of the medical profession. However, babies under 1kg at birth are often not resuscitated because their chances of survival are minimal. (This is not to be confused with “legal viability”, which relates to the 26-week cut-off date for abortion.)
Primary preventative healthcare must be weighed against extending life, particularly when there’s no guarantee that the quality of that life will be considerably improved. Three thousand young children can be vaccinated for the cost of one heart transplant. It’s a crude but real equation.