Managing the healthcare trilemma: broadening access to world-class care, maintaining affordability and enhancing benefits and services
Drickus Maartens • September 23, 2019
Discovery Health Medical Scheme contribution increases for 2020 ensure ongoing sustainability of quality healthcare benefits for members
Discovery Health Medical Scheme
announced the 2020 annual contribution increase and benefit changes. DHMS will be implementing a weighted average contribution increase of 9.5%. Based on a market survey of financial advisers representing over 250,000 lives, market expectations are for increases between 10% and 12% across the industry.
Dr Nozipho Sangweni, Principal Officer of DHMS explains, “The average increase for 2020 enables the Scheme to maintain and enhance benefits, while allowing for the increases in the demand for existing benefits, and the increases in the cost of those benefits. As a medical scheme, we remain focused on ensuring that all our members have access to the best quality care, while ensuring that contributions remain affordable for the long term.”
Discovery Health Medical Scheme also announced further enhancement of benefits, including a redesigned Comprehensive Series plan – Classic Smart Comprehensive. Following the success of its digitally enabled, network-based Smart Series, the Scheme has extended the design to its Comprehensive Series, to offer families attractive options for efficient, affordable comprehensive cover in 2020.
For DHMS, increases in the cost of healthcare claims can be attributed mainly to more members needing to use healthcare services, and members making use of these services more frequently. Dr Jonathan Broomberg, CEO of Discovery Health, provided examples of these increases, citing higher chronic-related claims as a significant contributor in the demand for healthcare and demand-side inflation. “Claims data for DHMS indicate that the incidence of chronic conditions has increased by 48% over the past 10 years due to the impact of lifestyle diseases on the medical scheme population in general. Members with chronic conditions claim 4 times more than healthy members, and are more likely to require hospital admissions related to their condition, which adds to the cost of medical scheme claims,” said Broomberg.
In his presentation to financial advisers, Dr Broomberg, provided an analysis of the cost drivers behind medical inflation and medical scheme contributions. “Medical inflation is the year-on-year increase in the cost of healthcare claims and is a critical consideration for medical schemes. Increases in the annual cost and number of claims have a significant impact on a medical scheme’s ability to provide affordable cover for healthcare services on an ongoing and sustainable basis.”
Discovery Health estimates total medical inflation for 2019 at between 10.5% and 12.5%, with the variance due to utilisation trends on the different health plan options. However, risk management by Discovery Health and the ongoing positive impact of Vitality on engaged members’ health, reduce medical inflation by 1.6%, resulting in plan specific contribution increases between 8.9% and 10.9%.
Broomberg said, “Contribution increases should be seen in light of the historic performance of the Medical Scheme and the ability to keep contributions and plan benefits stable and at a high quality. When comparing the annual contribution increases for the Discovery Healht Medical Scheme since 2008 with other open medical schemes, Discovery Health Medical Scheme’s annual contribution increases have been 1% or more lower on average each year. Maintaining this differential over time means members of DHMS have, on average, are paying 16.9% less for the same or better benefits in 2019, than members of other open medical schemes.”
Discovery today announced significant enhancements to its Discovery Primary Care product range, which offers employers affordable access to private healthcare outside medical schemes for their employees. In 2020, employees will have new benefits allowing them to use pharmacy-based primary healthcare clinics, which will increase the access to healthcare, and create affordable price points for employers. Discovery also announced household employers will be able to buy Discovery Primary Care for their household employees. Less than 1% of household employees are covered by private health insurance, and Discovery Primary Care now creates the opportunity to expand this cover significantly.
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The lives of millions of South Africans with a litany of rare diseases can be vastly improved, and even saved, by addressing challenges in identifying, studying and treating their conditions. With Rare Disease Day on the 28th of February 2025, the Rare Diseases Access Initiative (RDAI) is driving an evolution of the country’s healthcare, through innovative strategies to better care for over 4.2million people living with an estimated 7000 rare diseases. “As our healthcare system faces significant changes in the years ahead, it is vital that we also advocate for people living with rare diseases in South Africa, especially those with limited healthcare access,” said Kelly du Plessis, CEO of Rare Diseases South Africa (RDSA), a member of RDAI. “As part of our ongoing research and awareness efforts, RDAI has conducted an initial analysis of the incidence and prevalence of rare diseases within the country.” This research will assist in improving access to healthcare, policy development, and patient advocacy, while giving critical insight into the challenges faced by patients. “According to research, some rare diseases affect fewer than 1 in a million people, while others, such as Down syndrome, cystic fibrosis, and haemophilia, have a more recognisable prevalence,” says Dr. Helen Malherbe, RDAI lead researcher on rare disease prevalence data. “Many conditions are undetected, underdiagnosed or misdiagnosed, with too many having no information available about them at all.” The RDAI was formed in 2019 to promote a more favourable environment for those impacted by rare diseases in South Africa. Participants include Ampath, the Board of Healthcare Funders (BHF), Discovery Health, Genetic Counsellors South Africa (SASHG), the Government Employees Medical Scheme (GEMS), Health Funders Association (HFA), Medihelp, Medscheme, North-West University (NWU), Rare Diseases South Africa (RDSA), the South African Medical Association (SAMA) and The South African Medical Technology Industry Association (SAMED). The Council for Medical Schemes (CMS) participates as an observer. In the same year, Rare Disease International signed a memorandum of understanding with the World Health Organisation leading to an international rare disease policy framework. In 2021, the United Nations General Assembly moved to adopt a resolution recognising 300 million people living with rare diseases worldwide. “A general lack of awareness and delayed diagnosis remain major hurdles for those affected by rare diseases. Policymakers and healthcare stakeholders need to prioritise access to treatment, diagnosis, and support for rare disease patients,” says Bada Pharasi, CEO of IPASA, “Through this initiative, working collaboratively with stakeholders at every level of the healthcare supply chain, we can bring real and meaningful change to those affected, including family members and care givers, through smart and efficient strategies.” The globally agreed definition of a rare disease is any medical condition with a specific pattern of clinical signs, symptoms, and findings that affects fewer than or equal to 1 in 2000 persons in a population. “Most are genetic, and some are inherited and passed down in families,” Malherbe says. “Some affect only the patient’s genetic recipe, while others may be acquired during life due to infection, trauma, or environmental effects. For many, the cause is still unknown. “These conditions mainly affect children, as they are largely incurable and many are life-threatening. Some require specialised and co-ordinated care, some have limited and expensive treatment options, while others have no information or effective treatments at all,” she adds. The RDAI is calling for a patient-centred care model built on equitable access, transparency and efficiency. Naturally, this model calls for the open participation of patients, the healthcare industry, health professionals, and the Government. “The most critical elements are robust diagnosis standards, improved access to treatment, data collection and management, co-ordination of care, measurement of outcomes and ongoing collaborative research,” du Plessis says. “We need to establish rare disease advisory committees, map gaps and opportunities, establish system requirements, create a roadmap and plan a phased implementation with clear timelines.” The RDAI states that these policy development steps would be a start in quantifying the disease burden and defining standards of care. This would be followed by building and strengthening the capacity to facilitate appropriate diagnosis, treatment, continuity and data monitoring. Thoneshan Naidoo, Chief Executive Officer of the Health Funders Association noted that, “We appreciate the unique opportunity provided by RDAI which enables stakeholders across the industry to work together and identify strategies that improve equitable access to the appropriate diagnosis, treatment and healthcare services for rare disease patients, in an affordable and sustainable manner, taking account of the other pressing needs across the healthcare system.” “True innovation in healthcare is only possible through partnerships and joint advocacy efforts that raise awareness and improve access to treatment. Our long-term goal is the development of a rare diseases policy framework and guidelines for coordinated care,” says Pharasi. “Our members are united in the commitment to unlocking improved patient outcomes and improving access to services and robust health needs assessment facilities.” he concludes. About RDAI The Rare Diseases Access Initiative (RDAI) is dedicated to advocating for improved healthcare access, policy development, and patient support for those affected by rare diseases in South Africa. The initiative brings together key healthcare stakeholders, including pharmaceutical associations, funders, genetic specialists, and patient advocacy groups, to drive impactful change. About RDSA Founded in 2013, Rare Diseases South Africa (RDSA) is a non-profit organisation advocating to ensure that people living with rare diseases and congenital disorders experience greater recognition, support, improved health service and better overall quality of life. Started out of personal need following the diagnosis of organisation founder, Kelly du Plessis' son, it became evident that there was a lack of awareness and support for rare diseases in general in South Africa. About IPASA The Innovative Pharmaceutical Association South Africa (IPASA) is a voluntary trade association representing 24 leading pharmaceutical companies committed to research, development, and innovation. Our mission is to drive healthcare advancement by advocating for policies that improve patient access to safe, high-quality, and affordable medicines.
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