30 November 2016: SAMWUMED, a prominent medical scheme for local government and associated services employees, has announced that it will be extending its partnership with Medscheme, one of the leading medical aid health administration and managed care organisations in South Africa.

According to Neil Nair, Principal Officer of SAMWUMED, the Scheme engaged with Medscheme as its Hospital Benefit Manager in 2015.  “Through this partnership the Scheme has already yielded positive results in the areas of risk mitigation and in skills transfer.  Given the positive impact of this partnership SAMWUMED’s Board has agreed to extend its partnership with Medscheme to include its Medicine Management and HIV/Aids disease management programmes.”

Nair adds that the extended partnership with Medscheme will support the Scheme’s philosophy of integrating patient care such that healthcare interventions are more holistically managed – thereby enabling a more cost effective and indeed a more proactive healthcare experience by the patient. 

He added that integration at this level is also more enabling to allow for improved preventative care initiatives.Commenting on the HIV/Aids programme, he says that the Scheme is keen to ensure both best practice and keeping its members in the best possible treatment regime.  “To this end, we have appointed Aid-for Aids – a subsidiary of AfroCentric Health, Medscheme’s holding company to manage the SAMWUMED HIV/Aids programme. 

We are confident that the interventions will ensure that our afflicted members will be provided with a proactive and compassionate intervention.”Medscheme is proud to be the appointed managed care partner to SAMWUMED and we fully embrace, with SAMWUMED, the challenge of both reducing the cost of care, as well as improving the quality of such care,” says Kevin Aron, CEO of Medscheme.

Aron adds that its managed care services are designed to ensure that healthcare delivery is coordinated in the most efficient manner in order to facilitate care that achieves best possible health outcomes and service experience of members with the resources available. “The Medscheme Vision of ‘Building a World of Sustainable Healthcare’ is thus completely aligned to SAMWUMED’s core purpose of improving people's health and quality of life.”Medscheme is hoping to develop a true partnership with SAMWUMED where we leverage our collective strengths to radically transform the private healthcare funding industry in containing escalating healthcare costs, ensuring that healthcare outcomes are improved from a clinical quality perspective, and widening the access to care so that ultimately the beneficiaries of SAMWUMED enjoy a better quality of life,” says Aron.

SAMWUMED and Medscheme have both been active for decades in seeking to transform the healthcare industry so that high quality care is made accessible to the population of South Africa in an affordable manner. In addition, both organisations have been active participants on the Board of Healthcare Funders (BHF) - playing a leadership and mentoring role to the industry. With the long history of collaboration and partnering between SAMWUMED and Medscheme, the awarding of the managed care contracts by SAMWUMED to Medscheme further solidifies this relationship. An official signing of the partnership between the two organisations took place today at the SAMWUMED Head Office in Athlone, Cape Town.

SAMWUMED announces benefit improvements and premium increases13 October 2016

 

With a strong focus on providing affordable healthcare for its members in 2017, the self-administered local government medical scheme, SAMWUMED, has announced an average weighted benefit increase of 9% in 2017 for both its benefit options.

 

According to Neil Nair, Principal Officer of SAMWUMED medical scheme, the Scheme was able to keep its premium increases on both its benefit options in the single digits through a prudent costing cushion of very low non-healthcare costs (amongst the lowest in the industry), a cautious approach to tariff negotiations and a fair reserve ratio. Nair explains that having faced a challenging year thus far, similar to most South African medical schemes, SAMWUMED was forced to undertake a comprehensive review of its value offering to members and indeed new entrants to the market in 2017.

 

“Given the already unaffordable cost of medical aid, which prohibits lower income entrants into the market, we have endeavoured to stay true to our founding philosophy of quality healthcare at affordable rates.”He says that the SAMWUMED’s strong solvency ratio has also helped to ensure that increases are kept as lowest as possible.Nair says that it is no secret that, notwithstanding the burden of sickness afflicting our country, healthcare costs continue to soar within a largely unregulated South African market.  “For example, the impact of Prescribed Minimum Benefits at cost is beginning to show considerable negativity on healthcare affordability. Unfortunately, supply side manipulation adds pressure to an already volatile costing infrastructure. ”The recipients of these unfavourable conditions are unfortunately the members of medical schemes and South Africans in general, who end up bearing the brunt of increased costs, points out Nair.

 

“The scary reality is that most members of medical schemes have started to face double-digit increases in their premiums, adding increased pressure to already over-stretched household budgets.  The real cost drivers remain the cost of healthcare delivery.”This sentiment has been echoed by the South African Minister for Health, Aaron Motsoaledi, who earlier this year had also pointed out that, over the past 10 years, private healthcare costs in the country had risen by 300%.

These concerns resulted in the Competition Commission of SA conducting a market inquiry into the private healthcare sector, which is currently underway and has a strong focus on healthcare costs. “We are confident that the impetus by the Department of Health and the new leadership at the Council for Medical Scheme (CMS) will usher in a more responsible cost philosophy for private healthcare,” adds Nair.

 

In addition providing a low premium increase in 2017, SAMWUMED has also focused on improving a number of benefits for our members. Nair says that this includes; a 40% increase on in and out of hospital radiology and pathology benefits, child immunisations and screenings now being covered at private pharmacies, provision of wound care through primary care facilities, as well as improvements on both our preventative care and maternity benefit programme – amongst others.

 

“As a medical scheme focused on bringing good healthcare to families and communities alike, we remain committed to providing solutions that will help our members take better control of their health,” concludes Nair.

To help fight the cold this winter, SAMWUMED and Heart FM will be collecting beanies to keep children in need warm this month.

Spread the warmth this Mandela Month by dropping off a children’s beanie in person at the Cape Town Civic Centre, Delft Library, Fish Hoek Library, Gugulethu Community Health Centre, Heart FM, Kensington Community Centre, Khayelitsha Hospital, Mitchells Plain Community Health, SAMWUMED Head Office, SAMWUMED Medi Centre and Southfield Public Library.

You can also SMS the word BEANIE to 33882 to donate R6,70 towards SAMWUMED purchasing beanies for those in need.

All donations will go to children in need this Nelson Mandela Month.

We are pleased to announce that SAMWUMED has done it again!

In the recent Alexander Forbes Health Medical Schemes Sustainability Index, which was released last week, SAMWUMED has been ranked as the third most sustainable medical scheme in South Africa.

The index measures key factors that contribute to the sustainability of the 10 largest open and the 10 largest closed medical schemes in South Africa. This is based on; size and scale, membership growth and profile, financial results, as well as the scheme’s solvency levels.

According to the results, SAMWUMED was recognised for the growth in the size of the scheme, its significant improvements in its operating results in a tough economic climate, as well as substantial increases in both the Scheme’s reserves and solvency ratio.

This comes off the back of SAMWUMED walking away with the Titanium Award at the 16th annual BHF Conference. The Titanium Award for BHF Member of the Year is aimed at recognising and acknowledging excellence in the public and private healthcare sectors in Southern Africa.

The award is testament of the Scheme’s dedication to creating affordable healthcare for its members, as well as for its commitment to promoting universal healthcare in the country.

 
06 October 2015: Low benefit contribution increases, strong solvency levels, rich day-to-day benefits and a new Low Cost Benefit Option in the works all signal a positive growth trajectory in 2016 for the self-administered scheme, SAMWUMED. 
 
According to Neil Nair, Principal Officer of SAMWUMED, the restricted scheme, which caters for municipal and local government workers, has continued to improve its healthcare coverage offering to its members as well as improve the service that that it provides to them. 
 
Looking at the year ahead, SAMWUMED is pleased to announce that its average weighted benefit increase for 2016 will be 5.5%. Nair explains that the scheme has tried to keep contribution increases as low as possible for current and potential members, especially with the current healthcare cost inflation which is approximately 3-4% higher than CPI. 
 
The contribution increase for the scheme’s two benefit options, Option A and Option B, is 5.5% for both. 
 
“The low benefit contribution increase was largely due to the positive results that the scheme had achieved in 2014 and  anticipated in 2015,” points out Nair. “The scheme has been incredibly prudent with its spending, management of scheme risk and keeping non-healthcare costs as low as possible.”
 
Nair says that the scheme’s positive results has also lead to an expected increase of its solvency ratio to 78% at the end of 2015, increasing from 68.1% at the end of 2014. 
 
SAMWUMED has maintained the belief that by providing simple and yet comprehensive benefit options to its members, which have rich day-to-day benefits without a savings portion that ultimately means that the benefits and healthcare coverage is funded directly from the risk pool and not the additional burden to members by means of a double contribution.
 
Nair explains that within the value chain of healthcare, primary and preventative care plays a critical role. “Through it, the Scheme is able to better co-ordinate patient care, provide better management of chronic diseases and offer a wider spectrum of health services. These include, preventative care, such as cancer screenings; chronic care for conditions like asthma, hypertension and diabetes; and acute care for symptoms like stomach pains, cuts or high fevers.  Whilst these programmes are still at an inception level our plan is to grow these into meaningful vehicles for better management of dread disease.  More often than not misdiagnosis leads to costly and indeed risky outcomes for the patient”
 
“Prevention is always better than the cure and, through primary and preventative care, the scheme is able to easily detect patterns in a member’s health and recommend lifestyle changes to prevent future complications requiring expensive specialty care,” he adds. 
 
In keeping with the theme of providing strong primary and preventative healthcare benefits, Nair says that the Scheme shall be submitting a proposal to the Council for Medical Schemes (CMS) for a Low Contribution Benefit Option (LCBO) to be introduced into the SAMWUMED stable in 2016. 
 
SAMWUMED is excited about the new Low Contribution Benefit Option and will be launching, subject to approval by the CMS, by the second quarter of 2016.
 
A key challenge to the LCBO in local government is the tax threshold for eligibility as prescribed by CMS – whilst SAMWUMED supports the principle of a threshold to prevent buy-downs.  SAMWUMED would be submitting an application to up this limit to allow more low income workers to be eligible for this benefit.
 
The SAMWUMED LCBO proposal will be offering excellent benefits at a low cost for these new entrants into medical aid.  The Scheme expects that it will exceed the CMS minimum requirements.
 
“We believe that once this is approved by the Council, we will be able to further widen the coverage to potential members with an option that provides affordable benefits, with a strong focus on primary and preventative healthcare,” says Nair.
-Ends-
 
About SAMWUMED 
 
SAMWUMED is a self-administered medical scheme that fully complies with all criteria prescribed by the Medical Schemes Act. SAMWUMED has been in existence since 1952.  It was introduced by the Union (Cape Town Municipal Workers Association), predecessor to SAMWU (South African Municipal Workers Union), to cater for the health requirements of all local municipality and related agency workers.  Initially set-up as an industrial council type benefit fund, SAMWUMED has grown and transformed itself into a self-funded medical aid scheme, registered in terms of the Medical Schemes Act.  
 
SAMWUMED currently covers more than 92,000 lives under its administration. 
 
For more information visit www.samwumed.org 
 
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