Can responsible healthcare consumerism lower the cost curve?

Rising specialist and hospital rates, as well as increased medicine fees, are keeping many South Africans awake at night. Avoiding these escalating costs may be impossible, but medical scheme members can actually play a role in managing certain costs for themselves. Responsible healthcare consumerism enables people to take some control of their finances, and Medshield supports this growing trend.

Member education and the transparency of information are key to this process.

Duduza Khosana, Medshield’s executive principal officer, explains: “It doesn’t make sense for medical scheme stakeholders to operate in silos. Whether brokers, members, service providers or medical professionals, we can all bring something valuable to the table, which collectively amounts to a more favourable situation for the member.

“Education is the first step; and as an industry, we should be doing more to equip our members to make better purchasing decisions. For example, the notion of going for a second opinion – whether from a cost perspective or in terms of diagnosis – simply makes common sense.”

Most people do not realise the impact that their lifestyle choices have on their medical scheme’s day-to-day finances.

Making responsible, preventative decisions can assist in the sustainability of a scheme. Maintaining optimal health, as an example, can be better achieved by regular doctor’s visits. By getting the recommended check-ups and tests, consumers increase their chances of discovering medical problems early – before an illness significantly affects one’s health. The effect this can have on claims is substantial.

The same principal applies to the treatment of chronic conditions. Khosana comments, “If you have a chronic condition, you know your healthcare isn’t something you think about just once a year. You have far more frequent decisions to make, and a management programme – as devised by many medical schemes – can assist enormously.”

It is vital that, as a member-based organisation offering value-for-money healthcare cover for members, medical schemes provide a consistent product and service to all members. For this reason, responsible healthcare consumerism talks directly to stamping out “anti-selection”. This is the term used for the practice of joining a scheme with the sole purpose of claiming for a specific (and undisclosed) treatment, which is often very costly.

These members benefit unfairly over a member who has been contributing to the scheme on an ongoing basis.

Disclosing one’s full healthcare status as well as that of any dependants – including all chronic conditions, previous operations and family medical history – is a critical step in the application for membership.

It enables the clinical and the financial risk of both the member and the medical scheme to be well managed.

The ability to manage risk effectively is massively important to the longevity of a medical scheme, and plays a key role in ensuring it maintains a healthy solvency level and has a favourable claims paying ability.

A transparent and accountable approach to healthcare is one that everyone should adopt. Members are shooting themselves in the foot if they attempt to cheat the system.

Instead, medical scheme members can play an important role in their own finances and collectively – a responsible approach to the broader healthcare system by all stakeholders has far-reaching benefits.

About Medshield medical scheme

Medshield is one of South Africa’s largest medical schemes. Following the amalgamation with Oxygen, it has approximately 110 000 principal members, with a total of 254 000 lives covered (as of February 2011).

Medshield has eight healthcare benefits packages that provide members with a choice between traditional and new-generation options.

The scheme has once again been awarded an AA rating for its claims paying ability by Global Credit Ratings – the second highest rating a medical scheme can achieve.

For more information, contact Elizabeth Senger on (021) 425 7111.