Money saved through innovative strategic measures allowed Bonitas to emerge in a stronger financial position despite industry challenges. This resulted in a reduction in the overall net deficit experienced by the Fund, reducing it from R205.5m in 2015, to R16.9m in 2016.
“As one of the largest and most stable medical schemes in South Africa, our mission is to make quality healthcare more affordable and more accessible,” says Gerhard Van Emmenis, Principal Officer. “We have, therefore, focused on balancing costs while ensuring our members continue to receive rich benefits.”
It’s been a difficult few years for the healthcare industry, with medical schemes facing several challenges including economic pressures and escalating healthcare costs. In addition, medical schemes have to comply with the strict parameters of the Medical Schemes Act.
In spite of this, the Fund recently announced that its reserves have been bolstered to R3.1bn and it has also seen a significant growth in membership.
“Last year, we successfully concluded the largest amalgamation in the industry with LMS Medical Fund. This will continue to have a favourable impact on our membership as a whole, as a larger scheme is in a better position to negotiate tariffs in favour of our members,” says Van Emmenis.
The relatively low increase has not led to a reduction of benefits but rather an enhancement. “We’ve looked at the needs of our members and South Africa as a whole to introduce several new benefits in 2018. This includes a benefit for contraceptives and a mental wellness programme, among others.
“Increases are unfortunately inevitable given the high healthcare costs and inflation but we strive to keep premiums as affordable and accessible for all. Some of the benefits have been tweaked, others increased but all aimed at helping members take control of their health and lead better lifestyles and with South African socioeconomic factors in mind,” concluded Van Emmenis.
In times of economic uncertainty and political instability, healthcare costs and claims tend to increase – particularly with regard to anxiety and depression. Recent studies show that over 17 million people in South Africa are dealing with anxiety disorders such as panic disorder, post-traumatic stress disorder and mood disorders. In addition, statistics from a global study presented at a recent mental health summit in Johannesburg revealed that mental disorders have increased by 22.7%. In South Africa, 30% of people report life-long psychiatric disorders, while one in three will be affected by a mental illness in their lifetime.
A mental wellness programme has been developed and available in 2018 to identified beneficiaries on four plans. It provides access to specialised mental health doctors as well as education on managing the condition and support for loved ones too.
More benefits for families
Earlier this year Babyline was introduced, the first dedicated toddler’s health advice line to its members. In 2018, further benefits will be made available for Bonitas babies, including screening for congenital hypothyroidism for newborns under a month old across on all options. Screening all newborns for hearing loss is internationally recommended and these tests will also be covered on all options (in or out-of-hospital).
A focus on wellness and preventative care
Benefits that help encourage positive lifestyle changes and focus on preventing serious conditions are one of the key elements to reducing chronic disease prevalence. The Wellness Extender benefit has been increased by 15% to give members access to more consultations with a GP, dietician or biokineticist or cover for a programme to stop smoking. Pap smears for women over 21 years will now be covered on BonEssential and BonCap, once every three years and mammograms for women over 40, will be covered once every two years on BonSave and Primary to strengthen the preventive care benefits on offer.
PMBs – making benefits last longer
In previous years, out-of-hospital tests and specialist consultations for the management of Prescribed Minimum Benefit conditions (PMBs) were paid for from day-to-day benefits first on Standard, Standard Select and Primary. In 2018, cover for PMBs will be paid for solely from risk – allowing members to get maximum value for money and stretch their day-to-day benefits.
Optimised online systems and services
A new website features information on benefits and plans to help current members understand more about what their plan offers while potential members can select and choose a plan to meet their specific needs. A facility allows you to compare up to three plans on a like-for-like basis.
Further cost-containment initiatives
- Negotiating rates with healthcare providers and hospital groups to encourage members to use preferred providers to extend their benefits, limit co-payments and ensure they receive quality healthcare. Hospital admissions account for half of Bonitas’s annual claims costs, around R6bn. Through renegotiated rates Bonitas saw healthcare savings of R32m, negotiations remain key to managing costs.
- Increasing focus on prevention and utilization of managed care protocols in disease management and coordination of care and wellness through the Managed Care programme.
- Early detection and proactively managing the diseases are key components of this. This included using the Emerging Risk Model, an innovative tool to identify emerging risk members before they develop high-risk conditions. Bonitas’s back and neck, oncology, hip and knee and HIV/AIDS programmes respectively, continue to offer members emotional, clinical and financial support. These initiatives have also worked from a cost-containment perspective – leading to savings of over R100m in 2016 alone.
- Fraud, waste, and abuse in the healthcare industry are one of the main drivers of healthcare inflation and the increase in claims costs. The private healthcare funding industry spends over R150bn on private healthcare annually. A staggering 10-15% of these claims contained elements of fraudulent information – adding an estimated R22bn to the annual cost of private healthcare in South Africa.
To curb the impact Bonitas introduced advanced analytical software into the live claims environment last year. Using this, software the Fund was able to identify over R79m in irregular claims in 2017 for medical practitioners alone. Money which could have been used to pay for around 57,000 more GP consultations or 18 lung or liver transplants. The model is now being extended to include all pharmacy and hospital claims.
- An increased prevalence of chronic conditions and diabetes, in particular, is one of the key contributors to a rising disease burden. After reviewing the programme Bonitas developed the Diabetes Management Programme, in conjunction with the clinical team at Medscheme, to address diabetes as well as the specific comorbidities that it brings. This will allow for more holistic treatment and management of the condition which is tailored to a member’s specific needs.
Summary of changes for the year
- A weighted increase of 8.7% will apply to 2018
- A separate benefit for contraceptives will be added to all options
- Newborn hearing screening tests will be covered on all options (in or out of hospital)
- TSH test covered on all options for newborns
- Pap smears for women over 21 years will be extended to BonEssential and BonCap
- Mammogram screenings for women over 40, will be extended to BonSave and Primary
- Bone Density Screenings available on BonClassic and BonComprehensive will now be available to men aged 70 and over
- Children under 18 will no longer be required to complete the Health Risk Assessment to access the Wellness Extender.
- The family limit for the Wellness Extender will increase by 15% in 2018.
- Out-of-hospital tests and specialist consultations for PMBs paid from risk on Standard, Standard Select, and Primary
- A generous dentistry benefit package paid from risk to be added to BonFit
- Unlimited terminal healthcare benefit introduced on all options
- The corneal graft limit BonComprehensive, BonClassic, Standard, Standard Select, BonComplete, and BonSave will increase from R22,000 to R30,000.
- In addition, the sublime for specialized drugs for retinal disorders will increase from R42,000 to R50,000 on BonComprehensive, BonClassic and Hospital Plus.
- An internal prosthesis benefit of R30,000 per family (excluding joint replacement prosthesis) will be introduced to BonSave and Primary
- Introduction of the Bonitas Mental Health Programme
For more information on the range of medical plans available from Bonitas, or to compare options, go to www.bonitas.co.za.
Article by bizcommunity