Healthcare Fraud Awareness and Member Assistance

 

As members of a medical aid, we all want to be able to access the necessary level of healthcare in a time of need, covered by the monthly contributions we pay.

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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.

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