The toll of a pandemic on healthcare costs and provisioning

Adapting to a new way of enabling and delivering quality healthcare for members during an ongoing pandemic will be key in the approach of medical schemes in 2021.

According to Jacqui Nel, Business Unit Head of Healthcare at Aon South Africa, the industry has experienced a mixed bag of effects. One of the positive developments of the pandemic and the subsequent lockdown has been the industry’s ability to adapt to the new normal by swiftly embracing innovative diagnostic platforms. “The use of virtual care consultations with doctors and nurses has increased as did the adoption of telemedicine,” explains Jacqui.

However, one of the more concerning trends noted by the industry is a marked decline of members going for important preventative care and screening testing, together with a sharp decline in elective surgeries. “Prevention is always better than cure, and the later a patient is diagnosed with a serious illness or condition, the more complex the health implications become, in addition to treatments becoming more costly and possibly more protracted. In the case of critical illnesses such as cancer, a delay in diagnosis and commencement of treatment greatly impacts prognosis and survival rates. The pandemic will continue for months, and for this reason, we strongly recommend that members do not neglect their preventative health checks during this time. This includes your mental health. Many medical schemes offer mental health programs that will enable you to take care of your wellbeing, holistically,” says Jacqui.

Given the major financial challenges facing consumer households as a result of the lockdown, the affordability of maintaining medical scheme cover is another hurdle facing medical scheme members. The current economic challenges are set to continue well into 2021, and during this time it is vital to ensure that access to quality healthcare and cover are not compromised.

As financial pressures tighten, many medical scheme members are looking to change and downgrade their benefit options in a bid to save money. “Making the right decisions about the options selected within a medical scheme starts by understanding what benefits will be available and the affordability of the premium attached to these benefits. Benefits that are not covered will have to come out of your pocket, which needs to factor into your decision,” says Jacqui.

“The Medical Scheme Act currently protects members within the realm of Prescribed Minimum Benefits (PMBs), which enforces cover for 270 diagnosis and treatments of a defined list of chronic conditions and emergency care, assuring members of this cover.  The only precaution to take is to confirm whether the cover falls in the private or public-sector environment. Once that aspect is confirmed, a member can drill down to the day-to-day care offered in a medical scheme option and the subsequent affordability of it,” Jacqui explains.

While the healthcare industry is certainly rising to the challenge of finding innovative ways of making healthcare provision more affordable - such as virtual care options - it would be naïve to expect all the bells and whistles at a lower price. “At the end of the day it is about ensuring that you have good quality care when you need it most, with the option of adding the bells and whistles back into the mix when it is affordable to do so,” says Jacqui.

“Some medical schemes offer the option to upgrade benefit options within 30 days of a life-changing event. The peace of mind comes in knowing that a healthcare predicament requiring cover can be addressed at any time when the life-changing event occurs. Examples include enhanced oncology; a diagnosis of a severe condition not covered on your current option; or changing a network option in the case of a pregnancy where your specific doctor doesn’t practice within the network of your current option. It is an important aspect to consider when selecting your medical scheme and option of choice for 2021,” she urges.

By the middle of October most medical schemes would have announced their projected increases for 2021, together with benefit changes and new options. “We strongly recommend that you speak to your healthcare broker to examine your options in order for you to make an informed decision when it comes to finding an option that suits your specific needs and your pocket. Guiding, educating and protecting our clients is at the heart of all that we do,” Jacqui concludes.