Annual medical scheme claims expenditure rose on average by 11.3% a year over the past decade, far faster than consumer price inflation, which increased on average by just 6.1%.
The Discovery Health Medical Scheme (DHMS) data came from its administrator, Discovery Health.
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There has been much debate around the 1% value-added tax (VAT), its impact on consumers and just how this will affect the money left in their pockets at the end of the month. With the revised general fuel levy, it’s clear that consumers will have to tighten their belts and adhere to stricter budgets. The..
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These diseases were previously eradicated or made to cause fewer deaths, but are now threatening to make the comeback of the century. It was not long ago that having something as simple as a common cold was a life-threatening condition. With the advancement of medicine and technology, many of these ailments were mostly eradicated around..
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Hours after former President Jacob Zuma’s resignation, President Cyril Ramaphosa was pictured walking and jogging along the Sea Point promenade.
It wasn’t the first time he’d been spotted doing this.
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According to Discovery Health CEO, Dr Jonathan Broomberg, efforts to curb fraud in the healthcare system resulted in R568m recovered on behalf of client schemes in 2017, compared to R405m in 2016. Further, fraud-control activities in which health professionals and others contemplating fraud desist from committing fraud in reaction to visible policing and action by Discovery Health, prevented additional fraud to the value of approximately R3bn over the last two years, adds Broomberg.
Discovery Health has invested substantially in fighting the scourge of healthcare fraud. Efforts include the deployment of a specialised team of over 100 analysts and professional investigators as well as a proprietary forensic software system that uses sophisticated algorithms to analyse claims data and identify any unusual claim patterns. Invaluable tip-offs from whistleblowers also help to identify fraud.
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We entered 2017 reeling from a series of double-digit medical insurance premium hikes. It was becoming clear that schemes are in trouble; undercut by unregulated, selective insurance products and forced into tighter and tighter modes of managing care delivered.
We were facing an affordability crisis then – that, without serious systematic change, schemes will be unable to derail their progression towards shrinking memberships and eventual collapse.
Moving into 2018, scheme’s reserves are under threat, memberships are stagnant and the system continues, for the most part, to tolerate overutilisation of hospital services while failing to invest in strengthening community-level care. Alternative fee models remain tentative and marginal, neither inspiring nor supporting any structural changes in the fragmented way healthcare services are delivered. In light of this, I predict the following for the coming year:
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According to Discovery Health CEO, Dr Jonathan Broomberg, efforts to curb fraud in the healthcare system resulted in R568m recovered on behalf of client schemes in 2017, compared to R405m in 2016. Further, fraud-control activities in which health professionals and others contemplating fraud desist from committing fraud in reaction to visible policing and action by..
Continue reading…
We entered 2017 reeling from a series of double-digit medical insurance premium hikes. It was becoming clear that schemes are in trouble; undercut by unregulated, selective insurance products and forced into tighter and tighter modes of managing care delivered. We were facing an affordability crisis then – that, without serious systematic change, schemes will be..
Continue reading…
The National Healthcare Professionals Association of South Africa has filed papers in the Pretoria High Court accusing 19 medical aid schemes of spying on doctors and sneaking hidden cameras into their consulting rooms. The Sunday Times reported that medical aids are also allegedly holding back payments to doctors due to unproven misconduct. The association –..
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The ruling party says it’s time to get serious about funding and rolling out South Africa’s universal access to healthcare plan. Your medical aid tax credits could be back on the chopping block if a decision by the education and health subcommittee of the ANC’s national executive committee is anything to go by. The committee..
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