The toll of a pandemic on healthcare costs and provisioning

Adapting to a new way of enabling and delivering quality healthcare for members during an ongoing pandemic will be key in the approach of medical schemes in 2021.

One of the positive developments of the pandemic and the subsequent lockdown has been the industry’s ability to adapt to the new normal by swiftly embracing innovative diagnostic platforms. The use of virtual care consultations with doctors and nurses has increased, as did the adoption of telemedicine. 

However, a more concerning trend is a marked decline of members going for preventative care and screening testing, together with a sharp decline in elective surgeries. The later a patient is diagnosed with a serious illness or condition, the more complex the health implications become. It is pertinent not to neglect preventative health checks during this time, which includes your mental health. Many medical schemes offer mental health programmes that will enable you to take care of your wellbeing, holistically. 

The affordability of maintaining medical scheme cover is another hurdle facing medical scheme members. The current economic challenges are set to continue well into 2021, and during this time it is vital to ensure that access to quality healthcare and cover are not compromised. 

Many are looking to change and downgrade medical scheme benefit options to save money. However, making the right decisions about the options selected starts by understanding what benefits will be available and the affordability of the premium attached to these benefits. Benefits that are not covered will have to come out-of-pocket, which needs to be factored into the decision-making.

The Medical Schemes Act currently protects members within the realm of Prescribed Minimum Benefits (PMBs), which enforces cover for 270 diagnosis and treatments of a defined list of chronic conditions and emergency care. 

Confirming whether the cover falls in the private or public-sector environment is vital, from where a member can drill down to the day-to-day care offered in a medical scheme option and the subsequent affordability of it. At the end of the day it is about ensuring that you have good quality care, with the option of adding the bells and whistles when it is affordable to do so.  

Some medical schemes offer the option to upgrade benefit options within 30 days of a life-changing event, such as a pregnancy, which is an important aspect to consider when selecting your medical scheme and option for 2021. The peace of mind comes in knowing that a healthcare predicament requiring cover can be addressed at any time when needed. 

By mid-October most medical schemes would have announced their projected increases for 2021, benefit changes and new options. It is strongly recommended thast members speak to their their healthcare brokers to examine specific options to make an informed decision when it comes to finding an option that suits one’s specific needs and pocket.

*Jacqui Nel: Business Unit Head of Healthcare at Aon South Africa

**SOURCE: Article supplied by MediCoop