Key trends affecting medical schemes

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06 October 2020 - 09:08As a country, we started the year under huge financial pressure, facing a national deficit of R300bn. The global Covid-19 pandemic further affected our economy, bringing about forecasts that the economy would shrink by as much as 15%, Moody’s downgrading SA to junk status, and National Treasury estimating as many as two-million job losses.

As Medshield we were not immune to shocks arising from the pandemic, and we emphasised this at our virtual annual general meeting in September. In budgeting for 2021, a number of prudent financial assumptions had to be made. This included the anticipated health-care claims and the impact of the delay in 2020 surgeries, as well as the increase in tariffs for hospitals and health-care providers, and other expenses. We then had to net this off against the scheme’s current financial position and solvency levels.

In 2019, we covered more than 91% of members’ hospital claims across all our plans. Yes, we do have gaps, in part because some members chose to visit non-network hospitals or to have procedures that require co-payments. But overall, we ensure our members are covered when they need health care. As we are strong advocates in primary health care as a means for care-co-ordination and good-quality clinical outcomes, we have provided an additional two family practitioner consultations across all our Medshield plans when members’ benefits are depleted.2019 was characterised by a complex regulatory environment.

 

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