Being Prepared for Medical Scheme Members on the Road Ahead

It is hard to believe that we are already headed towards the final stretch of 2022. As we gear up for an exciting and busy time ahead with the scheme’s annual benefit updates, we’re taking stock of the year in healthcare up until now and just what we might be able to expect next. The repeal of COVID-19 regulations midway through the year signalled the beginning of the end of what has been a turbulent time for the healthcare industry and our country as a whole. This has created space for renewed conversations about how best to meet the needs of our members, which we are now, in many cases, approaching with different insights and a fresh perspective. Unfortunately, the economic fallout from restrictions imposed over the last two and a half years will continue to have a knock-on effect on consumers for some time. This will inevitably further cement the inequalities in our healthcare system with 86% of the population dependent on a heavily burdened and at times under-resourced public healthcare system, while the remaining 14% of South Africans have access to a private healthcare system that also has its limitations. This level of fragmentation has been further frustrated by industry restrictions on medical schemes trying to provide greater access to cover for quality care. There is a strong drive towards the provision of low-cost benefit options and hybrid healthcare cover which are designed to meet the most essential healthcare needs of South Africans who want to be sure that they are well taken care of should an unforeseen healthcare event occur. Furthermore, member-centric medical schemes are making product information as clear as possible to assist in informed decision-making when it comes to medical aid purchases. The effects of long COVID may very well change the wellness of our population, in other words, we may see more people diagnosed with cardiac conditions, diabetes mellitus, respiratory conditions, and possible kidney problems. Therefore there needs to be continuous active monitoring of our medical scheme members with regard to the development of complications and new conditions as a result of long COVID and to ensure that suitable benefits are in place to assist them where needed. There may well be an increase in the number of people diagnosed with such chronic conditions or even a progression of disease in those with existing chronic conditions, which in turn may require access to additional support in the form of specialised therapy, rehabilitation and medical oversight. Forward-thinking medical schemes are ensuring that proactive and adequate provision is made for the costs that may be associated with the changing healthcare status of the membership base in the future. COVID has taught us that it is important to continually monitor pathogens and factors affecting member health to identify short and long-term health risks. A sound medical scheme must have the resilience to withstand similar healthcare events in the future. If there is one thing that the past two and a half years have taught us it is that we, as an industry and as a nation, can work together when we are confronted with realities that require our most urgent attention. Some remarkable developments and collaborative efforts have come to the surface in recent years, and there is every reason why this should continue to be the case, provided that we can continue to work together towards the common goal of better healthcare access for all South Africans.