Headaches aren’t just for adults, kids get them too. But if the sufferer is a child, the discomfort can put parents under enormous strain and anxiety. Knowing how to handle and treat a headache in a youngster can help you and your child feel better.
Taking charge of your medical expenses has become increasingly important as healthcare costs continue to rise. Finding the right healthcare cover, that is affordable and meets your healthcare needs, is the first step. At this time of year, medical aid members are reviewing their options to ensure they make the right decision regarding access to the highest quality of healthcare, for the year ahead. It’s a delicate balancing act that needs to support your physical, mental and financial wellbeing. Lee Callakoppen, Principal Officer of Bonitas Medical Fund, provides some insights into how you can save on healthcare costs by using networks, Designated Service Providers (DSPs), opting for virtual care and generics to stretch your benefits. Using networks One way of reducing monthly medical aid contributions, without compromising on care, is to use a network plan. Generally, these are around 15% cheaper but, you must agree to use network hospitals. ‘We implement networks to negotiate the most favourable tariffs for our members so they can avoid out-of-pocket expenses and get more value,’ explains Callakoppen. ‘Using networks also means you can reduce or eliminate co-payments. ‘Members are seeing the value of hospital networks,’ he says. ’Around 1.2 million open scheme members are on a network option, accounting for 53% of the industry.’ If you choose to go with a network plan, ensure there are doctors and facilities in your area. Check what co-payment might have to be paid for not using a DSP or network. Don’t forget that network options are waived for emergencies. Co-payments Medical practitioners and hospitals often charge more than medical aid rates, this means medical schemes seldom cover the entire bill. A co-payment refers to the outstanding portion of the account, for which you will be responsible. Co-payments vary from one scheme to another. Tariffs and rates of payment Every medical scheme has a rate of payment: The amount the scheme will pay for that service. Some providers charge different rates known as the Scheme Tariff. Members often misunderstand that 100% of the scheme tariff/rate doesn’t necessarily mean 100% of the account or what you will be charged. Read the details of your plan carefully and know what rate is being paid and the benefit limits to avoid any surprises. Virtual has the Edge Technology is driving innovation and with the introduction of virtual integration and digital interventions, this is an ideal way to access healthcare, while stretching your benefits and minimising your monthly contribution costs. Designated Service Providers (DSPs) Healthcare costs in South Africa are unregulated, which means providers are free to charge any tariff, However, by using DSPs you can limit out-of-pocket expenses and co-payment and stretches your annual benefits. ‘Bonitas networks include over 4 000 GP practices, a pharmacy network of around 2 500 to dispense chronic, acute and over-the-counter medicine, around 3 000 dental practices and an optical network of over 2 300 practices. Use generics A generic is the exact copy of brand-name drugs. They have the same dosage, intended use, effects, side effects, route of administration, risks, safety and strength as the original. But they are much cheaper than the originals. – on average between 30 and 80% less. The Medicines Control Council (MCC) carries the responsibility of making sure that generic drugs are safe and effective in South Africa. Generic manufacturers have to prove their medicine is bioequivalent to the innovator brand before a product is allowed into the South African market. Benefits The benefits you receive vary depending on the plan you choose, make sure you read the fine print to understand what is and isn’t covered. Gap Cover Gap cover is an insurance policy, designed to cover the difference between what the medical scheme pays and the service provider charges for in-hospital procedures/treatment and specified outpatient procedures. The advantage of having a Gap Cover is that you are insured against some of these additional costs. However, never assume that all costs will be covered as the payment options depends on the product you have taken out, which is subject to limits and exclusions and you might still be asked for a co-payment. Medical savings A medical scheme allocates an annual fixed amount for medical savings – you need to know what this allocation is and whether you feel it will be adequate for your needs and you are able to tap into your savings for a number of medical expenses. Managed Care One of the key healthcare trends is the rise in non-communicable or lifestyle diseases, such as diabetes, high blood pressure and cancer. ‘80% of these conditions are caused by lifestyle risk factors,’ explains Callakoppen, ‘which is why we offer a range of Managed Care programmes aimed at assisting members understand and manage chronic conditions include cancer, diabetes, HIV/AIDS, mental health and back and neck pain.’ To this end use the supplementary benefits offered by your medical aid to save on significant day-to-day expenses such as: Blood pressure medication, cholesterol, blood sugar and Body Mass Index (BMI) measurements through to mammograms, pap smears and prostate testing. You can ‘work smart’ with your medical aid benefits. And wisely. Not only will you have access to quality healthcare but you will be able to extend your benefits.
If you’re expecting a baby then you’ll probably know that you’ll have a choice between a home or hospital birth. If a home birth is something you’re considering it’s important that you weigh up the relative pros and cons. A home birth means you’ll be giving birth at home as opposed to the hospital, and if this is something that you are considering it is important that you discuss it with your doctor. What are the benefits of a home birth? The first pro of a home birth is that you are at home, in a familiar environment with familiar people or trusted friends. It is only recently that hospital births have become so common, and prior to half way through the 20th century, most births did happen at home . Another reason why some moms choose to deliver at home is the fact that allows them to give birth with a lesser degree of medical intervention and they have more freedom in the birthing process. After giving birth you are able to be in the comfort of your own home with your new baby and family, another reason why home birth would be chosen over a hospital by moms. If you think this may be an option for you, you’ll need to find a midwife who has experience with home births so that if any issues should arise, she has a contingency plan to deal with the situation. The risk depends on your situation. If you are only carrying one baby, don’t have diabetes or high blood pressure, haven’t had a previous c-section and live around 15 mins away from the nearest hospital (in case of emergency) you are a more ideal candidate for a home birth. It’s important to weigh in on the possible risks before deciding if a home birth method is right for you and your baby. When would the hospital be a better option? Generally speaking, hospital births are safer because there are always doctors available in the case of an emergency, for instance if the baby becomes blocked in the birthing canal or the mom starts hemorrhaging. During your home birth, you may need to be transported to the hospital if your labour or birthing process doesn’t go to plan (that’s why it’s important to live close by to one if you choose this option). If your labour is slow, you need pain relief, the baby shows signs of distress or isn’t head first it’s best to be transported to the hospital for medical assistance. What do you need to prepare for a home birth? If you are seriously considering a home birth make sure you’ve consulted with your doctor to make sure this is a good option for you and your baby. If it’s something you want to consider, you’ll probably be wondering what you need to prepare for a home birth. Before getting to the details, you’ll need to choose a midwife or health care professional to assist, create a birthing plan, a well as a plan to prepare for a hospital transfer, should this become needed. If you still have questions, Home Birth South Africa, which is a website dedicated to home births in South Africa, has many resources you can browse through.
‘Blindness cuts us off from things but deafness cuts us off from people’ [Helen Keller] Hearing loss is more common than we think, up to 19% of South African school children suffer from varying degrees of hearing difficulties. Hearing is the foundation for speech and language development as well as learning and communication. The long-term impact of losing one of the key senses has a major impact on the quality of life. Early detection and treatment is vital and it’s important to conduct hearing tests throughout a child’s schooling. However, the reality is that many learners have limited or no access to audiological screening and treatment. To address this important health issue and close the gap on hearing impediments, Bonitas Medical Fund has partnered with humanitarian aid organisation, Gift of the Givers, on a project that will initially screen around 15 860 learners during 2023. ‘The Gift of the Givers Foundation is internationally recognised for its swift disaster response, community support and healthcare interventions,’ says Lee Callakoppen, Principal Officer at Bonitas. ‘We are truly excited by this partnership and we know this ambitious project will have a profound impact on so many lives.’ The importance of hearing tests According to the South African National Deaf Association (SANDA), children should have their hearing tested several times throughout their schooling: When they enter school, at ages 6, 8 and 10 and at least once during Grades 8 or 9 and Grades 10 and 12. This audiology project, which is being rolled out over a 10-month period, will initially test around 15 860 learners across Grade R to Grade 12 at various schools located in six areas in KZN: Umlazi, Indanda, Chatsworth, Phoenix, Marionhill and Durban central. The plan is to expand the project to other Provinces. Screening practicalities A South African manufactured portable audiometer, called the Kuduwave, will be used for the project. This state-of-the-art, medically certified device has revolutionised the testing and diagnosis of auditory related deficiencies. It combines a headset, audiometer and sound booth into a single, lightweight device, which can be used in just about any location. This means the audiology team can test learners at school. ‘Two Kuduwave units will be used to increase capacity and reduce downtime,’ explains the audiology team at Gift of the Givers. The programme is being overseen by an ear, nose and throat surgeon as well as an audiologist and speech therapist. They will provide training, consultation and oversight for the audiology team conducting the screenings. ‘Each test takes between 5 and 15 minutes,’ explains Gift of the Givers audiology team. ‘During which time the learner’s middle ear will be pressure tested for ear infections and ears will also be checked for inflammation and earwax. Diagnostics and after-care If the screening fails, a full diagnostic test will be undertaken. ‘This project not only covers the screening but goes a step further and offers an after-care element. This includes follow-up medical treatment, if required, to ensure learners receive the assistance they need so that their development is not delayed,’ explains the audiology team. ‘I cannot even begin to imagine a life without sound,’ says Callakoppen. ‘Not hearing someone’s voice, the lyrics of a song, rain falling on a roof or laughter. As a medical aid we advocate for prevention through early screening, detection and treatment for any ailment – including hearing.’
It’s the time of year when medical schemes announce revised contributions, benefits and enhancements for the year ahead. With all the options it can be a little confusing, which is why you need to be smart by doing due diligence to ensure you choose a medical aid that provides the cover you need and is affordable. It’s also important to look at how you can manage your medical expenses to make your healthcare benefits last. ‘There are 17 open medical schemes in South Africa, each with their own set of plans and benefits,’ explains Lee Callakoppen, Principal Officer of Bonitas Medical Fund. ‘It can be a little overwhelming trying to decide what is best which is why we advise consulting a medical aid broker or financial advisor.’ Brokers are accredited by the Council of Medical Schemes (CMS) and are qualified to offer advice and support at no extra charge. Together you can work your way through the different options, ahead of choosing a medical aid plan. Brokers also know the financial stability of the schemes, which should be a consideration in the final decision. A starting point, with or without a broker, is to compare what is available. Most medical schemes offer a range of healthcare options – from traditional medical aids through to hospital, savings, network or income-based plans that can make private healthcare more affordable. So, what should you consider? Affordability is key Take a careful look at your monthly budget to determine what you can afford. The rule of thumb is that contributions should not exceed 10% of your monthly income. However you also need to take a look what the plan you’re considering offers and whether there are additional costs, such as co-payments. A medical aid co-payment is a fee that the member is liable for when making use of certain medical services. These co-payments usually apply to specialist or elective medical procedures and differ from one medical aid scheme to another. Your health status Assess your current health status and that of your family so that you can determine what cover you need. Specifically, consider pre-existing conditions or ailments, together with any chronic medication or treatment that you or your family make use of as well as how often you visit a doctor or specialist and what you spend on dentistry or optometry. Then reflect on what expenses over the past year were once-off (like childbirth) and which are likely to come up time and again – such as flu. This will help you decide on whether you need a comprehensive medical aid or a hospital plan. The fine print It’s important to take the time to read all the information. Benefits vary from plan to plan, so you need to establish what is and isn’t covered. Check what supplementary benefits are available that can potentially save significant day-to-day expenses. These could include preventative care benefits, ranging from basic screenings for blood pressure, cholesterol, blood sugar and Body Mass Index (BMI) measurements through to mammograms, pap smears and prostate testing. In some cases, these extend to maternity programs, dental check-ups, flu vaccinations and more. Once you understand what is on offer, you can make an informed comparison and decision. Managed Care Managed Care programmes help members manage severe chronic conditions such as cancer, diabetes and HIV/AIDS. Ask whether the scheme you are considering has a managed care programme. Medical savings A medical scheme allocates an annual fixed amount for medical savings – you need to know what this allocation is and whether you feel it will be adequate for your needs. Daily detail Look at what the scheme suggests will help make your benefits last, bearing in mind the following: Are you required to use a specific GP, hospital network or Designated Service Providers (DSPs)? Although this helps keep costs down, you need to check the network in your area before making a final decision Having to be referred to a specialist by your GP? Does your medical plan offer additional GP consultations, which they will pay for, after you have exhausted your day-to-day benefits? Technology Technology and virtual care are being embraced by medical schemes, even more so since the Covid-19 pandemic. Check what is offered on the plan you’re considering and also whether you’re able to access your benefits, submit claims, find healthcare providers, WA chat and access your medical information online 24/7. Age will impact your decision If you have young children, ensure that the medical aid option you select provides sufficient child illness benefits. For young couples looking to start a family: Does the option provide sufficient maternity benefits? However, if you are slightly older, ensure you select an option that covers chronic conditions and provides sufficient in-hospital cover in the event of hospitalisation. Waiting period and exclusions The Medical Schemes Act and the specific scheme’s rules determine this. Callakoppen recommends that you enquire with the relevant scheme about their exclusion list and waiting periods. Financial stability of the scheme With two medical schemes recently being placed under curatorship, it’s important to choose a medical scheme with a solid track record and reputation. Check the claims payment record … do they pay on time? Equally important is the demographics and size of the scheme. Has the membership of the scheme grown over the past few years and what is the general age? And finally, take a look at the annual contribution increase, in fact a good idea is to look at the increases over the past three to five years to see how these compare with the rest of the industry. ‘Health is the new wealth,’ says Callakoppen. ‘Your health is important, as are your finances, don’t take either for granted. When it comes to healthcare cover, invest time to research and understand what you need. If in doubt, phone the call centre, your broker or financial advisor to ensure you find the right medical scheme to walk the healthcare path with you.’
Your baby’s health during your pregnancy solely depends on you – what and when you consume is important to both of you. Intermittent fasting is a diet that many turn to to lose weight and improve health. This is a time restricted form of fasting and you may wonder if it’s healthy to keep up this kind of eating while trying to get pregnant or when you are pregnant. Is it safe to fast while I am pregnant? Fasting during your pregnancy is not recommended. While there is research that shows this may be a good way to help with weight loss and potentially reduce the risk of type 2 diabetes, this is not ideal when your body needs more calories than normal. While pregnant your nutritional focus should be to make sure that your baby is getting all the right vitamins and minerals. While in the initial stages of pregnancy you might not need more calories than normal, as your pregnancy progresses you will need to eat more – making fasting a less viable option. However, if you are struggling with morning sickness (most prevalent in the first trimester), you’ll find that eating bland foods little and often can help ease the nausea, which isn’t compatible with fasting for hours at a time. Not only will snacking help keep the nausea at bay, but it’ll also keep your blood sugar stable. While there aren’t studies that look at intermittent fasting throughout pregnancy, it has been found that moms-to-be with lower glucose levels had lower fetal movement, which can be a warning sign of potential issues during your pregnancy. Can I start intermittent fasting straight after birth? If you’ve decided to eat regularly during your pregnancy, you may wonder if you can return to your old lifestyle after having your baby. However, while you are breastfeeding it’s best to stick to a regular eating schedule. Even after birth your body will be needing extra calories for breastfeeding – restricting these can lead to reduced milk supply
Most parents know that during the course of raising a child you will have to deal with different bouts of illness. Here is some information, from Bonitas Medical Fund, which should help you to manage common early childhood illnesses successfully.
At a glance: 340 119 Principal members 709 881 Total beneficiaries 190 000 new members over the past 36 months Average age of beneficiary: 33.9 Average age of new members is 15 years younger than existing members R7.4 billion in reserves 36.5% solvency ratio AA Credit rating Plans Bonitas offers a wide range of plans that are simple and easy to understand. There are 15 options in five categories: Savings, traditional, hospital, Edge (virtual) and income-based. Increases A three-month price freeze will apply in 2023: From January to March contributions remain the same as 2022 The average increase, across all plans, is 5.9%. However, factoring in the three-month price freeze, the average increase drops to 4.8% Plan increases range from 0% to 9.4% BonStart has a 0% increase By applying very low contribution increases since December 2020, the Scheme has effectively passed R1.4 billion in savings back to members Nine plans are priced under R3 000 per main member’s monthly contribution The most popular plans, with newer members, include Primary, Primary Select, BonFit, BonEssential, BonEssential Select, BonStart and BonStart Plus Note: Contributions from April 2023 What’s new? Bonitas has introduced a mental health app – in partnership with Panda. It’s a free to download mental health and wellness mobile app that uses scientifically validated assessment tools and appropriate treatment to provide the right care at the right time. Panda will be available from October 2022 The Hospital-at-Home initiative has been successful and the offering is being extended to include: A programme for re-admissions Screening and disease prevention Alternative to stepdown facilities Kidney dialysis at home An improved programme for chronic kidney disease Restructured benefits are unlimited for PMB cancers across all plans. With a set Rand amount where non-PMB cancer cover is available. Once the Rand limit is exhausted, a 20% co-payment will apply Cover for two doses of the vaccine Human Papillomavirus (HPV) for girls aged between 9 -14 years, on BonComprehensive, BonClassic, BonComplete, Standard and Standard Select Introduction of one booster vaccine for Pertussis or whooping cough, per beneficiary aged between 7 and 64 years on Standard, Standard Select, BonComplete, BonClassic and BonComprehensive. The savings component across the savings plans have been increased from between 5% to 9.4% and amended rules allow members to use their savings as they deem fit for the new year The Benefit Booster – introduced in 2022 which unlocked R446million in additional benefits – has been adjusted according to utilisation Footprint and networks Our footprint extends across all 9 provinces, with our membership concentrated in Gauteng, KwaZulu Natal, the Western Cape and the Eastern Cape. A GP network of over 4 400 An extensive Pharmacy network, with around 2 500 practices located in all nine provinces to dispense chronic, acute and over-the-counter medicine through Scriptpharm Dental network, through DENIS, provide access to around 3 000 practices across SA Optical network through PPN gives members access to over 2 300 practices
For many parents, nothing is as stressful as getting your kids to eat all the food on their plate, especially when it comes to veggies. Eating a variety of healthy foods is essential for your children’s wellbeing. Here are some tips on how to get your kids to eat better.
Even though generic drugs have been around for more than half a century, many patients in South Africa are unreasonably suspicious of what is. In essence it’s a ‘carbon copy’ of the original brand of drug or medicine. Bonitas Medical Fund believe it may be because consumers think that if they are cheaper they must be inferior. This lack of understanding costs consumers and medical aids millions of Rands each year.
The Covid-19 pandemic and the resultant lockdowns affected people across the world – mentally, emotionally and physically. These included feelings of isolation, work stress, frustration at rules and regulations, fear for close family and friends and a loss of control over your life. So, it is not surprising that we have seen an increase in mental health related issues. 1 in 6 South Africans suffer from anxiety, depression or substance use disorder. Over the last two years the prevalence of anxiety and depression disorders has increased by 36.4% and 38.7% respectively. 970 million people worldwide have a mental health or substance abuse disorder. A study by the Global Happiness Council (GHC) shows that mental illness is the main ailment among people of working age. Dr Morgan Mkhatshwa, Head of Operations at Bonitas Medical Fund says, ‘This has a massive effect on employers as they try to cope with keeping their businesses going, preventing job losses and maintaining a happy and motivated workforce. The economic uncertainty, political instability and poor socio-economic conditions in South Africa have also added to the burden of mental health issues in South Africa.’ To make matters worse, according to South Africa’s National Mental Health Policy Framework, ‘up to 80% of South Africans who need mental health support are unable to easily access it’. In addition to a comprehensive mental health programme, Bonitas is the first medical aid to offer Panda to its members. It’s a free to download mental health and wellness mobile app that provides scientifically validated assessment tools to enable users to objectively measure their mental wellbeing. A gamified tracking tool allows you to document and monitor the progress you’re making on your personal mental health journey. This includes: Engaging in interactive, audio-only sessions with peers and mental health experts in the ‘Bamboo Forest’ Learning new skills through assignments and videos to help you live a more fulfilled life Tracking your mental health progress to measure how you are feeling Getting text-based chat support from an accredited wellness counsellor Booking 1:1 virtual consultations with accredited and registered counsellors, social workers, psychologists and other mental health professionals ‘The level of support depends on the degree to which you need help,’ says Dr Mkhatshwa. ‘This ranges from level one, where there is an easy access point to community, information and support, through to level 5 where Panda will notify you to contact emergency services. We know how tough it can be to go through difficult times all by yourself, but with Panda, you will be able to find the support and resources that you need. In a nutshell: The right care at the right time for a healthy mind, using your phone.’ What is mental illness? Mental illness is defined as ‘any behavioural or mental pattern that causes significant distress or impairs normal functioning’. It can occur as a once off, be persistent or recur. The common denominator being the debilitating nature of the condition. It is a medical condition A mental illness affects the way a person experiences and behaves in the world around them. It is a recognised medical condition in the same way as chronic diseases, such as diabetes and high blood pressure and can affect anyone, regardless of race, religion, income or age. It is not a sign of weakness or madness and is nothing to be ashamed of. The good news is, it’s a condition that that can be managed and treated successfully. Anxiety disorders and depression are the most common mental health problems but others include eating disorders, Post-Traumatic Stress Disorder (PTSD), obsessive compulsive disorder (OCD), bipolar mood disorder as well as psychotic disorders such as schizophrenia and personality disorders. Substance abuse, such as drugs and alcohol, is also classified under mental illness. Battling the stigma The Mental Health Society acknowledges, ‘The social stigma attached to mental ill-health and discrimination exacerbates patients’ condition. It often prevents people from seeking treatment. And, if they do, makes it harder to recover.’ Dr Mkhatshwa says, ‘Fortunately, increasingly well-known and influential people who are suffering from or have overcome mental illness, are being more open about it. This will go a long way to debunk myths, negativity, discrimination and judgement’. Recognising the signs These can vary but, in general, these include: Being frequently sad, depressed and gloomy for long periods and feeling overwhelmed by life’s problems Major changes in eating habits, resulting in weight loss or gain Struggling to concentrate and make decisions Loss of energy and lack of motivation Constant stress and anxiety over work, finances, life, friends and family Emotionally distant Frequently tearful Having difficulty sleeping or sleeping more than usual Loss of interest in activities Easily irritated and more aggressive than usual Having thoughts of death or suicide Drug or alcohol abuse may also be a sign of underlying mental illness Help is at hand There are specialised mental health programmes in place through most medical aids and most mental illnesses can be effectively treated by health professionals and community-based services or NGOs. This may include access to medication, therapy and counselling. The Mental Health Programme (MHP) from Bonitas, which forms part its Managed Care initiatives, is aimed at improving quality of life and empowering people with mental health issues to manage their condition. It is education driven and offers support for loved ones too. ‘The introduction of Panda will dovetail neatly with our MHP,’ says Dr Mkhatshwa. ‘Mental illness cannot be wished away,’ says Dr Mkhatshwa. ‘We can’t expect someone to ‘pull themselves together’, they simply can’t. But with the right support and help, symptoms will be relieved and the recovery rate is encouraging with patients getting back to being happier, more productive members of society.’
Bonitas Medical Fund, one of the leading medical schemes in South Africa, announced its 2023 product line up today. Lee Callakoppen, Principal Officer of Bonitas says, ‘Our average increases for the year would have been 5.9% – well below the current inflation rate of 7.6%. The good news is that we’ve put a price freeze on contributions for the first quarter of 2023, to offer our members some respite. This effectively means an increase of 4.8% over the 12 months. We have also shared exactly what members can expect to pay from 1 April 2023, so that they can make informed decisions. Bonitas celebrated its 40th anniversary this year and has evolved and expanded its capabilities over the past four decades in response to the needs of a growing membership base. ‘It’s always a delicate balancing act between keeping increases as low as possible while maintaining the stability of the Scheme,’ says Callakoppen. ‘The guidelines, set out by the Council for Medical Schemes (CMS) in Circular 44 of 2022, requested medical schemes to keep contribution increases for 2023 below CPI. However, over the past decade medical scheme contribution increases have outpaced inflation by around 4%. We are delighted to have kept these well below CPI itself. In fact, by applying very low contribution increases since December 2020, the Scheme has effectively passed R1.4 billion in savings back to members. And, with the challenges we’ve seen recently in the healthcare industry, we know that promoting sustainability is key. So, we’re happy to boast excellent financial indicators from high solvency ratios, strong reserves and a high claims-paying ability. Not only is the Scheme financially sound with over R7.4 billion in reserves but, over the last 36 months we have signed up 190 000 new members. This figure is significantly higher than the size of most schemes in the industry. Even better for sustainability is that the average age of our new members is around 15 years younger than the current membership. It reinforces the fact that we are succeeding in attracting a younger, healthier profile, which is coveted across the industry. The future of healthcare is anchored on primary and preventative care as well as sustaining well-being, as opposed to responding to illness. One of the key healthcare trends is the rise in non-communicable or lifestyle diseases, such as diabetes, high blood pressure and cancer. 80% of these conditions are caused by lifestyle risk factors which is why we offer a range of Managed Care programmes aimed at assisting members understand and manage their conditions. Cancer care Cancer prevalence is one of the key concerns facing South Africans and is increasing year on year. Last year, we announced our partnership with the South African Oncology Consortium – the largest network of oncologists in the country to enhance the offerings of our cancer programme including screening for early detection, treatment and palliative care. For 2023 we have restructured benefits to be unlimited for PMB cancers, on all options. Diabetes The latest data from the South African Health Quality Assessment, shows that Bonitas has an effective disease management programme and better outcomes than the industry standard for diabetic members, with improved metrics for Hb1Ac, statins and cholesterol. But, as we always look for ways to improve, we are proud to introduce a benefit of R51 000 per family per year for an insulin pump or continuous glucose monitor for type 1 diabetics over 18 years. Mental health We are pleased to announce that we’ve introduced an innovative new digital solution, called Panda, to support our members in managing their mental wellness. Panda, a free to download app, offers everything from audio sessions with peers and mental health experts to one-on-one virtual consultations with mental health professionals. We encourage our members to complete a mental health questionnaire in the Bonitas Member App to assess their mental health status. Panda will be available from October 2022. Benefit Booster Launched last year, the Benefit Booster was one of the most innovative changes to hit the medical schemes industry and aimed at supporting our preventative care strategy. It unlocked R446 million in additional benefits for members to extend their day-to-day benefits. For 2023, we’ve opted to adjust the benefits limits in line with utilisation with enhancements seen on several plans. Designated Service Provider (DSP) We implement networks to negotiate the most favourable tariffs for our members so they can avoid out-of-pocket expenses and get more value. These networks are carefully selected to maintain high levels of healthcare, aligned with our brand promise of providing quality healthcare. We have restructured our options to include a wider hospital network component. In 2023, 85% of our members will be within a 30km radius of a network hospital – with a presence across all nine provinces in line with the footprint of our member base. This includes a GP network of over 4 400 of the most efficient practices in the country, an extensive pharmacy network, with around 2 500 practices to dispense chronic, acute and over-the-counter medicine through Scriptpharm. Our dental network, through DENIS, is one of the largest on the continent – providing access to around 3 000 practices while our optical network through PPN gives members access to over 2 300 practices. Medicine formulary We have aligned our medicines formulary to the WHO’s Essential Medicines List (EDL) to promote affordability and accessibility to clinically approved medicines, in support of Universal Health Care and promotion of medicine adherence for our members. Hospital-at-home The technology-enabled Hospital-at-Home service brings all the essential elements of in-hospital care to a patient’s home, without moving away from evidence-based clinical protocols and state-of-the-art 24hr vital sign monitoring. 1 200 members have used the offering to date – equating to around 6 000 days in hospital. We are extending the offering to include: A programme for re-admissions, screening and disease prevention, alternative to stepdown facilities and kidney dialysis at home. Savings We’ve amended our rules to allow members to use their savings as they deem fit for
Non-communicable diseases (NCDs), known as lifestyle diseases, pose some of the biggest threats to the health of South Africans. They are a result of the way we live, combined with genetic, physiological, environmental and behavioural factors. The most common are hypertension (or high blood pressure), diabetes and obesity. It is imperative to have regular or annual check-ups. Dr Morgan Mkhatshwa, Head of Operations at Bonitas Medical Fund, offers advice about these tests and others specifically for women. Weight and BMI Almost 70% of women in South Africa are overweight or obese. The Body Mass Indicator (BMI) is used to check if you are a healthy weight. To calculate your BMI: Divide your weight in kilograms (kg) by your height in metres (m) Then divide the answer by your height again Good to know Underweight <than 18.5 Normal weight 18.5 to 24.9 Overweight 25 to 29.9 Obese 30> Diabetes With over 4.6 million people in South Africa living with diabetes, it’s important to check your blood glucose. There are two main types of diabetes: Type 1 and Type 2. They are different conditions but are both serious and need to be treated and managed properly. One of the biggest problems with diabetes is when it remains undiagnosed. This can lead to blindness, heart attackstroke, kidney failure, impotence and amputation so it’s vital to be checked. Blood pressure Hypertension (high blood pressure) is when blood pressure stays elevated over time. It is often referred to as the ‘silent killer’ since nearly 33% of people who have it, don’t know it. If your blood pressure is too high, it puts extra strain on your arteries (and your heart) and if it’s not treated, hypertension can cause kidney failure, eye problems and heart disease. Good to know Range Normal 120/80 to 129/84 Upper end of Normal 130/85 to 139/89 Mild hypertension 140/90 to 159/99 Moderate hypertension 160/100 to 179/109 Severe hypertension More than 180/110 Besides testing for these three main NCDs, Dr Mkhatshwa also advocates specific checks for women. A Mammogram From the age of 18 you should do regular self-examination of your breasts, if you see or feel any changes, consult your doctor immediately. Early detection increases the chance of survival and can save your life. Some doctors recommend having a mammogram, every two years from the age of 40, others believe you only need to start at 50 years of age. A mammogram is a low-dose X-ray which radiologists analyse to look for changes in breast tissue. Although the greatest risk for breast cancer is age, women can get breast cancer from a very early age. Cervical cancer South Africa has a high rate of cervical cancer, this has been attributed to the fact that not enough women are screened regularly. Screening can detect early changes in the cervix which can be treated and save your life. Screening includes: Pap test (pap smear) which looks for cell changes (pre-cancers) in the cervix that may progress to cancer if not treated. The Human Papillomavirus (HPV) test. Looks for the virus that causes most cervical cancers It is recommended that between the ages of 21and 65, women should have a pap smear every two years and, from the age of 30 onwards, a pap smear and HPV test can be done every 5 years A vaccine has been developed to protect women from getting HPV. It is administered free of charge, annually, to girls between Grade 4 and 7 (9 to 12 years of age) in all government schools. The HPV vaccination can be a cost-effective strategy in lowering the cervical cancer risk among women in South Africa. Bone Density As you age, your bones become thinner and weaker. Over time this can lead to a condition called osteoporosis. If you’re aged 65 or older a bone density test is recommended. Called a DEXA scan, the frequency of this screening varies depending on your bone density and other risk factors. Your doctor may suggest you have this test earlier if you: Broke a bone in the past Have taken steroids for a long time Have rheumatoid arthritis Are underweight Have a parent who has broken a hip after a minor injury Treatment for osteoporosis is available – usually the first choice is Bisphosphonates. Colorectal Cancer Screening These tests look for cancer in the colon or rectum by checking for tissue growths, called polyps. If you don’t have an elevated risk for cancer, then you should start having these tests when you turn 45. A colonoscopy, where the doctor looks at your entire colon, should be done every 3-10 years depending on what is found during your exam. A Faecal Immunochemical Test (FIT) should happen annually. The FIT is also a screening test for colon cancer which tests for hidden blood in the stool, which can be an early sign of cancer. Skin Checks Skin cancer is caused by the abnormal growth of skin cells – usually on the skin that has been exposed to the sun but not always. There are three major types of skin cancer: Basal cell carcinoma, squamous cell carcinoma and melanoma. Examine your skin carefully at least once a month and, if you are prone to getting lots of moles, go to a dermatologist and have the mole ‘mapped.’ If skin cancers are found early and treated, they are almost always curable. If you have a history of skin cancer in your family have your skin checked regularly by a doctor. Remember early detection of any of these conditions can save your life, so remember to go for regular check-ups with your doctor.
Asthma is one of the most common chronic illnesses, affecting over 339 million people worldwide. According to the World Health Organisation (WHO), asthma kills around 1 000 people every day and the prevalence is rising. South Africa is ranked 25th worldwide for asthma prevalence and is ranked fifth for asthma mortality. The lack of appropriate diagnosis, treatment or access to care may be important considerations in tackling asthma morbidity and mortality in South Africa. What is asthma? Asthma is one of the most common respiratory complaints in the world where your airways – known as bronchial rubes – become inflamed. This swelling or inflammation makes the airways extremely sensitive to irritations and increases their susceptibility to an allergic reaction. In an allergic reaction, the airways swell and the muscles around the airway tighten, making it difficult for air to move in and out of the lungs. It affects approximately one in 10 children (10%) and one in 20 adults (5%) and can occur for the first time at any age, even in adulthood. Although asthma usually begins before the age of five, a few children affected will ‘outgrow’ it during their teenage years but it usually persists if contracted in adulthood. Asthma tends to run in families, as do related allergic conditions like hay fever and eczema Signs and symptoms Asthma is often under-diagnosed and under-treated. If you fail to recognise and avoid triggers that lead to your tightened airways, you may have an asthma attack, feel respiratory distress or experience a life-threatening situation. So, it’s important that you know how to avoid the triggers and recognise the signs of this condition to enjoy a better quality of life. Symptoms can range from mild to more serious depending on the severity of the illness but include: Coughing that does not subside and gets worse at night Wheezing Shortness of breath Tightness or pain in the chest What causes asthma? The exact cause of the asthmatic process is not well understood but it is thought to be triggered off by an allergy or when the lungs are irritated by something in the air. Research shows that the risk facts are a combination of genetic predisposition and environmental exposure to inhaled substances and particles that may cause allergic reactions or irritate the airways. These include indoor allergens – such as dust mites and pet dander in the home, outdoor allergens – such as pollen and mould as well as tobacco smoke and air pollution. Other triggers can include cold air, stress or physical exercise. Certain medications, such as aspirin and other non-steroid anti-inflammatory drugs and beta-blockers (which are used to treat high blood pressure, heart conditions and migraine) can also set off an asthma attack. Factors associated with asthma prevalence or disease severity in South African children include the adoption of an urban lifestyle, atopy (a genetic predisposition),obesity, respiratory infection, or exposure to industrial pollution or tobacco smoke. Treating asthma Asthma can be life threatening when left untreated and cannot be cured but, with the right treatment most asthmatics will lead completely normal lives. The aim of treatment should be to make the lungs and breathing tubes as normal as possible so that there are minimal symptoms and as little disruption to ordinary life as possible. Get help Bonitas Medical Fund says, ‘If you are experiencing asthma symptoms or think you might have asthma, it is important for you to talk to your GP. This will help you establish if your symptoms are linked to asthma or whether something else is causing them.’
As a new mom, the birth of your baby is a beautiful and exciting time, but there is a darker side to childbirth. Postpartum depression affects about 15% of moms after delivery, and while it is a serious disorder it can be overcome through treatment. What is Postpartum depression? Feelings of anxiety, sadness and fatigue are common after birth and are often referred to as the ‘baby blues’ and should subside within the first two weeks. However, if these feelings stick around for longer, you could be experiencing postpartum depression. Restlessness, mood swings, insomnia, irritability, disconnection from your baby and feeling of worthlessness are all red flags for postpartum depression. Some moms feel guilty or ashamed to be feeling this way, however PPD can affect any woman. Don’t be afraid to reach out for help, as PDD is treatable through both medicated and unmedicated options. What should I do if I have the symptoms of Postpartum Depression? The good news is that PPD is treatable. There are a variety of common types of treatment, which depend on the type and severity of symptoms. Treatment can include counselling, therapy groups, antidepressants and hormone therapy. Self-help groups can be helpful, as it allows you to connect with others who have experienced similar problems and stop feelings of isolation. Recovery time will also vary from mother to mother, but untreated the disorder will last much longer and can interrupt mother-child bonding. Getting help does not mean you are a bad mother, it is important to reach out if you are feeling depressed. Postpartum Psychosis In rare cases moms can develop postpartum psychosis. This should be treated as a medical emergency, and it is essential that you receive help right away. Symptoms include paranoia, delusion and erratic/disorganised behaviour. How to deal with mental health after pregnancy Your mental health is critical to you and your child’s well-being. If you are worried about PPD it is important to get professional help. However, you can help your mood by slowly getting back into exercise, setting aside time for yourself and leaning on those around you for support. It is important to stay connected to family and friends so that you don’t feel alone.
When you’re looking for positive, purposeful, swift action in a time of crisis there’s one organisation you know you can rely on. The Gift of the Givers Foundation is always ready to step in when needed, getting on with the job at hand with the minimum of fuss but with maximum results. ‘The Gift of the Givers needs no introduction,’ says Lee Callakoppen, Principal Officer of Bonitas Medical Fund. ‘The organisation continues to go beyond the call of duty to bring humanitarian aid where needed. It has built its reputation on the principles we, as a corporate citizen, also value: Respect, care, professionalism and dedication. Their swift and problem solving response in the face of any disaster – be it a pandemic, fire, flood, earthquake, tsunami or war – is to be highly commended. And we are proud to announce that Bonitas will be partnering with them for the year ahead.’ For 30 years this extraordinary, non-governmental disaster response organisation has been responding to global challenges, in an effort to bring hope, life and restore dignity to the most vulnerable of people. Gift of the Givers primary focus is disaster response but other key areas of assistance include hunger alleviation, water provision, healthcare, education and social upliftment. Headed up by medical doctor, turned humanitarian, Dr Imtiaz Sooliman, Gift of the Givers has repaired and restocked hospitals, run clinics, sunk boreholes, dug wells, provided food and shelter to millions … and so much more. And, more recently, during the Covid-19 pandemic, KZN riots and water shortages in the Eastern Cape, the NGO brought relief to those who needed it most. ‘Our association with Gift of the Givers goes back a few years when we supported various projects on an ad hoc basis. However, recently we reassessed and realigned our CSI strategy to be in sync with our mantra: ‘A Medical Aid for South Africa’,’ says Callakoppen. ’This means us investing in the social upliftment of South Africans. And who better to partner with than this leading philanthropic organisation. The Bonitas values align with that of the Gift of the Givers and we look forward to working with them to provide relief to the most vulnerable and marginalised communities, specifically in the field of healthcare interventions.’ ‘We joined Bonitas as our medical scheme in 2019,’ says Dr Sooliman. ‘We worked with our financial advisors to find the most appropriate scheme and plan for our staff and have been impressed with their service, professionalism and how the member always comes first. As a paypoint for the Fund, we interact with the team regularly and, through these interactions, have realised there is synergy in our ethos. This led to us working alongside them on selected projects but we are thrilled they are formalising a partnership with us.’ Sooliman says the private sector plays a vital role in helping the organisation fulfil its humanitarian vision. ‘By working in partnership with like-minded and committed corporate partners, we have the ability to make a real difference in the lives of some of the most vulnerable people across South Africa, throughout Africa and the world.’ ‘We have handed over an initial R500 000k that will be used for healthcare related disasters,’ says Callakoppen, ‘However, additional funding has been set aside for specific healthcare related projects, such as hospital revamps, that are close to the hearts of both the Fund and Gift of the Givers.’ ‘I have been fortunate to meet Dr Sooliman on a few occasions and he has engaged with our Bonitas Board,’ says Callakoppen. ’It was humbling to learn more about the healthcare interventions they have put in place, the impact these have had and also just how much they can achieve in a day. He is passionate about the work they do and has a solid belief in the common humanity that unites us. This resonates throughout the organisation, leading with integrity and honesty. We look forward to the lessons we will learn while working alongside them on future projects.’
Everyone is feeling the pinch and looking for ways to stretch their budget. This is true of healthcare too, especially when it comes to medical cover. It’s important to manage your medical expenses if you want your benefits to last. The smart move is to know what your plan offers and what you can do to avoid unnecessary out-of-pocket expenses. That way you can save money while managing your health. Lee Callakoppen, Principal Officer of Bonitas Medical Fund, give us some tips on how you stretch your medical aid benefits. Understand your plan and what it offers Knowledge is power and when it comes to medical aid this is especially true. Firstly, it’s important to make sure you have chosen the right plan for your healthcare needs. If you’re battling to make a decision, consult an independent broker. Brokers are accredited by the Council of Medical Schemes so are qualified to offer advice and support and there’s no extra charge for this service. Then, read through the plan you’ve selected and understand all the benefits, limits as well as any additional rules, regulations or added value benefits. Use DSPs or networks Using network doctors, specialists, hospitals or Designated Service Providers (DSPs) is essential if you want to make your medical aid last longer. It means you won’t be charged more than the negotiated preferential rates. Remember this includes knowing your scheme’s key providers, such as which ambulance to call in an emergency. Not using a DSP can result in a co-payment or non-payment for the service. Ask your pharmacist Consult your pharmacist for advice on over-the-counter medicine and/or switching to generic medicines. Using generic medicine, which has the same active ingredient, strength and dosage as the original brand but is less expensive, helps save costs. In addition, consider using a clinic or nurse practitioner to get your blood pressure screened, for your flu vaccination and other primary healthcare concerns – this saves on the consultation fee charged by your GP. Managed Care benefits Most schemes offer programmes to help you manage chronic conditions such as cancer, diabetes, HIV/AIDS and back and neck problems. These programmes are usually covered from the risk portion of your medical contribution and are not funded from your savings account. They help you use your benefits to maximum advantage while ensuring you receive quality care by using specific providers. Other benefits – such as maternity consultations, wellness benefits, preventative care and dentistry – are also paid from risk by some schemes. Again giving you more value for money and are in addition to your savings and day-to-day benefits. Boosting your benefits Carefully read through what your plan offers – especially when it comes to enhanced benefits – and choose wisely. Remember, not all additional benefits are equal. For example does your plan cover childhood vaccines from risk? If so, this is a saving of thousands of Rands, especially in the first 18 months of life This year, Bonitas invested R446 million in additional benefits through a benefit booster which is available on all plans, including the hospital plan (but excluding BonCap). Members tap in by completing a wellness assessment (which can be done online) and then have access to additional benefits which range from R940 and R2 730 (depending on the plan) to cover expenses such as: GP and specialist consultations Acute and over-the-counter medicine Biokineticist and physiotherapist consultations and treatment Paramedical services Alternative healthcare X-rays Blood tests Go virtual Look out for telemedicine or virtual consultation options which are around 60% cheaper than an average consult. A doctor will engage with you in a virtual video consultation on a medical issue and advise you on the most clinically appropriate steps for further care. Be inquisitive, ask questions Ahead of any procedure, in or out of hospital, ask the right questions. Check that your healthcare provider is on your scheme’s network in order to secure a better rate. Unless the procedure is an emergency, you will need to get pre-authorisation. At the same time, request a quote so you know, upfront, what the costs will be and whether you will be covered or if you are being expected to make a co-payment. If so, negotiate. Stay healthy With Non-Communicable Diseases (NCDs) or lifestyle disease fast becoming a pandemic in South Africa, it’s important to take care of your health by eating correctly, getting enough sleep, exercising and reducing your stress levels. ‘Health is the new wealth,’ says Callakoppen. ‘Your health is important, as are your finances, don’t take either for granted. When it comes to healthcare cover, invest time in researching and understanding the medical aid plan you’ve selected. Read the information sent to you, including the fine print to understand the Scheme Rules. If in doubt, phone the call centre, your broker or financial advisor. This will go a long way in helping you know your rights and making the most of your benefits.’
Wherever possible, consumers are tightening their belts and looking at ways to consolidate expenses and save money. Healthcare is no exception. Traditionally, members of medical aids re-evaluated their medical cover annually, to coincide with increase announcements as well as changes to plans and benefits which come into effect on January 1 each year. However due to the pandemic, a number of medical aid schemes have deferred or postponed their increase announcements. This new pricing is being introduced at different times during the year and at varying percentages – often above inflation. ‘This has caused some confusion and challenges,’ says Lee Callakoppen, Principal Officer of Bonitas Medical Fund – which opted not to defer increases. ‘Members are free to change their options, once a year, during the open period. However, with deferred increases, this often falls out of the open period. This means members start paying the increased premium after to change options has closed.’ Callakoppen explains that the medical aid industry is highly regulated with specific rules and regulations that could impact changing plans and moving schemes. These include waiting periods, late joiner fees and accumulated savings – that all need to be considered when changing plans Can you change your membership any time during the year? You can change at any time but usually this happens during open period. When changing, waiting periods might apply and the savings allocation of the plan may be affected. Make sure you have not already used more than a pro-rated percentage of the benefits or you might have to replay it. This will happen if you have depleted the savings’ portion before the end of the year and switch to another medical aid. What is a waiting period? According to the Medical Schemes Act, medical aid schemes are entitled to impose waiting periods – there are two categories: General waiting period (up to three months) and a condition-specific waiting period (up to 12 months). This protects other members of the Scheme by ensuring individuals can’t make large claims shortly after joining and then cancelling their membership. When do waiting periods apply? Waiting periods generally apply if you move from one medical aid to another, you or your dependants were not on a medical aid for a period of at least 90 days before you joined, or you have never been a member of a medical aid. Can these be waivered? Waiting periods can be waivered but this depends on the medical scheme. Do you pay premiums during a waiting period? Yes, you continue to pay your full premium during the waiting period. What if you change from one scheme to another? Your specific details and medical history will be considered, for example pre-existing medical conditions, how long you have belonged to a medical aid, etc., and underwriting may apply. What is a late-joiner penalty? Schemes can impose late-joiner penalties on individuals who join after the age of 35, who have never been medical aid members or those who have not belonged to a medical aid for a specified period of time since April 2001. Can you move directly from hospital insurance to medical aid? Late-joiner penalties will apply if you are over the age of 35 and move from a hospital insurance to any form of medical aid (including a hospital plan). Does the late-joiner penal reduce over time? No, unfortunately not. Once you are paying a late-joiner penalty, it remains in place. ‘The bottom line is that members need to do due diligence if they are considering switching medical plans or schemes. They need to evaluate the monthly contribution against the benefits being offered and make sure they will cover their healthcare needs,’ says Callakoppen.
With COVID19 prevalent globally, the thought of your baby catching a cold could be one to send shivers down your spine. But don’t fret, here are the symptoms of the common cold, what is considered normal and what is cause for concern. What is a cold? The common cold is caused by a variety of different viruses, and is an infection of the throat and nose. When a baby is born they have a weaker immune system, which develops as they grow older. Understandably though, this makes it easier for them to catch a cold. Babies do build up antibodies when they are exposed to germs, however, it takes 2 to 3 months for their immunity to fully develop. There are many types of viruses that are the cause of colds, but luckily most colds will help increase your little one’s immunity against other another nasty germs. What is normal and what can I do to prevent my baby catching a cold? Unfortunately, as the cold is caused by viruses there is no cure for it, but you can try naturally calm your baby’s symptoms. Unfortunately antibiotics won’t work as viruses are the culprit. It is normal for a cold to last 7 to 10 days. Symptoms include a runny nose, cough and low grade fever. Although alarming, fever is your baby’s natural response to the virus. Don’t give over the counter medication to your baby as these can cause dangerous side effects in young children, but extra fluids, saline spray and air humidifiers are all things you can use to help your baby. When a cold causes your baby to have trouble breathing, a high fever or dehydration it is time to consult with a doctor. Additionally, if the cold lasts for an extended period of time without getting better it is also best to seek professional help. Babies often catch the virus from older siblings or daycare, so if you can limit your baby’s exposure to other people this will help prevent them picking up unwanted viruses. Ask visitors to wash their hands before touching your little one and make sure to keep the baby’s utensils and towels separate from the rest of the household. Keeping your baby up to date with vaccinations is also a very important action that can help protect your them.
Recently there has been increased discussions around male menopause. However, research shows that not all doctors and psychologists agree that there is a definitive male menopause or andropause. Dr Morgan Mkhatshwa, Head of Operations at Bonitas Medical Fund, says this is because not all men experience it and, for those who do, they often don’t express their feelings as freely as women – as a result only a few men exhibit ‘midlife crisis’ symptoms. What is ‘male menopause’? It is the decline in the levels of the male hormone testosterone in men, just as women’s levels of estrogen begin to decrease, any time from the age of 40+. Some doctors refer to it as low testosterone. It is normal to experience a decline in the production of the male hormone testosterone with ageing but this also occurs with conditions such as diabetes. This gradual decline of testosterone levels is called late-onset hypogonadism or age-related low testosterone. It is a more gradual than female menopause where ovulation ends and hormone production plummets during a relatively short time. When does ‘male menopause’ start? Andropause or male menopause can begin at about age 40 (but can start earlier) and continue into the 70s. Why is it not talked about more? There is not much research into the subject, probably because you don’t die from the reduction in gonadal hormones and the withdrawal of hormones is not as dramatic as in women. Together with the reduction in hormones, there are often other factors involved when men experience this. For example, work pressure, marital pressures, life management and lifestyles exacerbate the problem. Many practitioners believe that balanced, youthful levels of human hormones improve the quality of life. What are some of the symptoms? Decreased mental sharpness (poor concentration, depressed mood) Decreased energy and strength Weight gain, decreased muscle and increased fat Depression and/or loss of eagerness and enthusiasm Irritability Sore body syndrome (feeling stiffness) Hot flushes or sweats Cold hands and feet Itching Poor sexual function Height loss Dr Mkhatshwa says some men feel the pressing need to make major changes because they feel ‘life is too short’ or have a feeling of dissatisfaction with their career, marriage and health. This can lead to restlessness about changes in appearance and making out of character choices, such as having an affair or a sudden desire for excitement or thrilling experiences. Getting help Men cope with menopause in different ways, it depends largely on their personality. The reduction in hormones often coincides with children leaving home, friends getting sick, marriages in trouble and job horizons narrowing. Combined with physical, psychological and sexual symptoms it is critical for men to acknowledge the challenges and seek the help of their family doctor, spouse, friends and support groups. How does one test for male menopause/andropause? It’s best to make an appointment with your GP who will: Perform a physical exam, ask about symptoms, order tests to rule out medical problems that may be contributing to the condition and do blood tests, which may include measuring testosterone level. Helping your body and mind cope with andropause Diet: A healthy diet, which includes a balance of vegetables, fruits, meats, fish and dairy products Fitness: Engage in regular exercise, including aerobic, muscular and flexibility exercises Get regular health check-ups including cardiovascular, prostate and testicular cancer Check hormone levels as you get older. Generally, between 40 and 55 several important hormones in a man’s body begin to decline Reduce stress in your life. Exercise and relaxation help to reduce stress, as does talking to your partner, friends and family about your problems Although sex is still important as you go through male menopause, you will start to view sex as a part of a loving relationship which includes friendship, intimacy and sharing Get plenty of sleep What about Testosterone Replacement Therapy (TRT), does it work? Medical experts are divided on this. It may improve the sexual function to some extent but there is no evidence that it improves any other symptoms. Are there any dangers or side effects? Men should avoid TRT if they are at high risk of prostate cancer, have severe urinary symptoms from prostate enlargement, have diagnosed heart disease, sleep apnea, a combination of risk factors for a heart attack or are prone to thrombo-embolic events. TRT does have associated risks, including: Worsening sleep apnoea (a potentially serious sleep disorder in which breathing repeatedly stops and starts) Causing acne or other skin reactions Stimulating noncancerous growth of the prostate (benign prostatic hyperplasia) and growth of existing prostate cancer Enlarged breasts Limiting sperm production or causing testicles to shrink Stimulating too much red blood cell production, which contributes to the increased risk of forming a blood clot Fluid retention, etc. Unlike menopause in women, Dr Mkhatshwa believes more research is needed on andropause or male menopause to completely understand it and determine what can be done to assist men through this phase of their lives.
Being pregnant is an exciting time of your life, but it can be a little daunting. Morning sickness is one of the aspects of pregnancy that can be difficult to deal with. It is estimated that over 70% of women deal with nausea and vomiting to some degree. The name morning sickness is also misleading, as unfortunately you can feel sick anytime of day. Morning sickness is often one of the first signs of pregnancy, beginning in the first trimester. Unless vomiting is so frequent that it leads to weight loss and dehydration (this is known as hyperemesis gravidarum), morning sickness is considered a normal (albeit unpleasant) part of pregnancy. What causes morning sickness? There is no one cause of morning sickness, and severity varies amongst women, and between pregnancies. Some women deal with feeling nauseous the entire pregnancy, whereas others will find that symptoms abate within the second trimester. Luckily, even though you may be feeling miserable, morning sickness is often seen as a sign of a healthy pregnancy and doesn’t harm your baby. Morning sickness is thought to be caused by hormonal changes during pregnancy, specifically the pregnancy hormone, known as human chorionic gonadotropin. How to deal with morning sickness? Unfortunately there isn’t anything you can do to fully alleviate the nausea and vomiting, however, there are things you can do to help fight feeling sick. Making sure you stay hydrated, eating a bland diet, such as rice, bananas and crackers, as well as eating small amounts frequently are all things that can help quell the queasiness. Try staying away from strong smells and spicy foods, as these can trigger nausea. If your morning sickness is bad, speak to your doctor, and be sure to consult with them before trying any medication or alternative remedies.
Becoming a parent is a joy but it can also be overwhelming and just a little daunting. There is no degree or diploma, you are simply propelled into it. It’s a steep learning curve. You instantly have a new life depending on you and, combined with sleep deprivation, the challenges of adjusting to being a parent and wanting to do the best for your child, you need all the help you can get.Becoming a parent is a joy but it can also be overwhelming and just a little daunting. There is no degree or diploma, you are simply propelled into it. It’s a steep learning curve. You instantly have a new life depending on you and, combined with sleep deprivation, the challenges of adjusting to being a parent and wanting to do the best for your child, you need all the help you can get.
Ten people die in South Africa every hour from Tuberculosis (TB). It is and has always been, a serious public health issue that needs to be brought under control. Even though effective treatments are available and there has been considerable progress in fighting the disease – about 450 000 people develop TB every year. Dr Morgan Mkhatshwa, Head of Operations at Bonitas Medical Fund, talks about the state of our nation in terms of TB, the leading cause of death in our country. Of the 450 000 people who develop TB every year, just over half are living with HIV. Although most cases are drug-sensitive and respond well to standard treatment, failure to complete the full course encourages the development of multi-drug resistant TB (MDR TB), which is difficult to treat and has poor outcomes. Is TB a pandemic like Covid-19? TB is considered an endemic but arguably has the criteria to be given pandemic status. According to the World Health Organization (WHO) a pandemic is when: The disease causes death There is persistent transmission between people It spreads in multiple countries An endemic is when the disease is still circulating but at a lower, more predictable rate. The only plausible reason is that the levels of TB are consistent and predictable, rather than the ‘boom and bust’ waves of Covid-19. That said, just because it’s endemic doesn’t mean to say it’s not serious. Smallpox, for example, was endemic for thousands of years and a third of the people who were infected, died. Malaria is also endemic and causes around 600 000 deaths a year. Dr Thandi Dlamini-Miti, senior technical advisor: TB at health NGO Right to Care says, ‘Undiagnosed TB is driving transmission of the disease. Many people with TB don’t know they have it because they don’t have symptoms but they are infecting those around them with this potentially deadly disease.’ Is there enough research and development for TB drugs? The short answer is no. Countries with resources, funds and technical capacity (developed countries) have not invested in the field of TB because the disease has not affected them. It is a disease that flourishes in developing countries, where living conditions are often poorly ventilated and over-crowded. Over 95% of cases and deaths are in developing countries. Another factor to consider is that, although the poor bear the brunt of the burden of ill-health (up to 13X greater incidence of TB), they also have access to far fewer services compared to the rich. Some good news recently came from Right to Care though. Dlamini-Miti says, ‘Since July 2020, a TB prevention treatment called 3HP has been piloted. It is considered a game changer because treatment is shorter, less toxic, promotes better adherence, has a higher barrier to resistance and is safe with first-line antiretroviral therapy.’ Latent TB, HIV/AIDS and immunity TB can be ‘latent’, in other words you have TB in your body but it is not active. You aren’t ill and you can’t spread it. However, if your immune system becomes weak for some reason, the TB becomes active and will make you ill. Having HIV/AIDS is a key factor in the TB epidemic which is why it’s imperative that the almost six million people living with HIV are screened and treated. Latent TB treatment is fairly low cost and can be taken together with anti-retroviral drugs. Despite this, the number of people on medication is only a fraction of those who are eligible. Diagnosing TB Diagnosis is quite complex (particularly for those living with HIV) since many symptoms are similar to those for other common diseases. South Africa has moved towards more intensive and active methods of identifying cases, for example by screening all those attending primary health clinics. The aim is to move from identifying fewer than 70% to 90% of all cases. Currently the process of testing most of the population is a protracted one. The TST (skin test) and blood tests do not differentiate between latent and active TB which means a sputum sample needs to be taken or a chest X-ray. This is both costly and time consuming. A quicker, cheaper method of testing would certainly assist to diagnose TB. Treating TB Current treatment for TB still includes many of the original antibiotics that were developed in the 1950s and 1960s. While newer antibiotics have been introduced, they are still used in combination with the originals whose side effects cannot be ignored. Similarly, BCG is still the only known TB vaccine administered to children in developing countries. Is there a vaccine that can protect adults? Unfortunately not, there is only the BCG for babies, which has become the most widely used vaccine and provides protection to children against miliary and meningeal TB. It provides limited protection against pulmonary TB, which is the most common form of TB. Has TB been affected by the Covid-19 lockdown? Yes, it has reversed years of global progress in tackling TB and, for the first time in over a decade, TB deaths have increased, according to the WHOs 2021 Global TB Report. How is TB contracted? It is transmitted through the air, not by surface contact. Transmission occurs when a person inhales droplets with TB nuclei and it travels though the mouth or nasal passages via the respiratory tract into the lungs to reach the alveoli of the lungs. Each person with TB can spread the disease to another 15 individuals over a year. Who is most at risk of contracting TB? People living with HIV (especially those newly diagnosed or not virally suppressed), living in the same house as someone who has had or has TB, anyone who has had active TB in the last two years, those with diabetes, residents of informal settlements, children under five, the undernourished, alcoholics, smokers, mineworkers, prisoners and pregnant women. How prevalent is TB amongst medical aid members? Protocols required by the National Department of Health dictate that all TB positive patients must be referred to the state for treatment. This means
The seasons are changing and with winter on its way, which heralds the start of the ‘flu season’. We chat to Dr Morgan Mkhatshwa, Head of Operations at Bonitas Medical Fund on why a flu vaccine is recommended, not just by the Scheme but also the World Health Organization (WHO). 1.Why should I get a flu vaccine? Although the flu vaccine will not eliminate your risk of developing flu, it helps reduce your chances of severe infection. Annually, seasonal influenza (flu) kills around 11 500 people in South Africa which is why it is a good precautionary measure to take. 2.How are Covid-19 and flu viruses similar? WHO says that Covid-19 and influenza viruses are similar in disease presentation. ‘Firstly, they both cause respiratory disease, which presents a wide range of illness from asymptomatic or mild through to severe disease and death. ‘Secondly, both viruses are transmitted by contact, droplets and any material that can carry infection. As a result, the same public health measures such as hand hygiene and social distancing is recommended.’ 3.What are the essential differences between Covid-19 and flu? Flu is an acute viral respiratory infection, transmitted by the influenza virus. There are three types of influenza, namely Influenza A, B and C. Covid-19 and influenza are essentially different viruses with SARS-CoV-2 being a newly discovered coronavirus that causes Covid-19. 4.Why do I need a flu shot every year? The flu virus changes every year, this means last year’s vaccine will not keep you safe this year. The vaccine helps your immune system fight off the virus by producing antibodies – the soldiers in your body that battle the flu virus. 5.What vaccines have been developed for 2022? The flu vaccines available for this year are: The Vaxigrip Tetra, Influvac and Influvac Tetra. 6.Can I get the flu vaccine and a Covid-19 vaccine together? As per the National Covid-19 Vaccination Programme Circular 3 of 2022, the answer is yes. However, it is recommended that if you decide to have both vaccines at the same time, then one should be on the left arm and one on the right. 7.Who should get a flu vaccine? It is recommended that anyone in the High-risk groups including: Healthcare workers Individuals over 65 years of age Individuals with chronic diseases – or comorbidities – for example: Cardiac disease, hypertension, stroke, diabetes, asthma, chronic obstructive pulmonary disease, kidney diseases, etc. Pregnant women People living with HIV/AIDS 8.Who should NOT have the flu vaccine? Individuals who are allergic to eggs or egg proteins as the manufacturing process for the vaccine involves the use of chicken eggs Infants under 6 months of age – the vaccines are not licensed for use in such young children Individuals who may have had a severe reaction to a flu vaccine in the past – if you are unsure discuss with your healthcare provider Individuals who may be suffering from flu symptoms already 9.Will the flu shot give me a mild flu? According to the Centre for Disease Control (CDC), ‘A flu shot cannot cause flu. Flu vaccines are currently made either with flu vaccine viruses that have been ‘inactivated’ and are not infectious or with no flu vaccine viruses at all. The most common side-effects from the vaccine are soreness, redness, tenderness or swelling where the shot was given. Serious allergic reactions to flu vaccines are very rare.’ 10.Still not convinced? Flu viruses spread very quickly from person to person. Even if the flu vaccine is not 100% effective against the current flu strain, it will reduce your risk of getting flu and, if you do get it, it will be a great deal milder. More importantly, by having the flu vaccine you protect others, who may be vulnerable family members, small babies, the elderly or those who are immune compromised. As with Covid-19, the more people vaccinated the closer we can get to ’herd immunity’.
Symphysis pubis dysfunction or SPD is pain in your pelvis, which is caused by the relaxing of ligaments in the pelvic bones too early before birth. Many aspects of pregnancy can cause discomfort, and SPD is one of them. Here are the signs of SPD and what you can do if you think you to alleviate your discomfort if you are suffering from it. What is SPD and what causes it? Not all moms-to-be will experience SPD but it is thought to be fairly common in pregnancy. SPD is a pain in the symphysis pubis (which can range from moderate to serve) caused by the relaxing and stretching of the ligaments around the pelvic bone. Pain can be brought on by opening your legs, walking up stairs or even turning over in bed, and this may be accompanied by a clicking/grinding sensation in the pubic area. The cause of SPD in pregnancy is the hormone relaxin, aptly named as it relaxes your joints and ligaments to make it easier for your baby to come out at birth. SPD happens when these hormones come into play too early. Not only that but you’re shifting centre of as your baby grows, which can cause main in your lower back and pelvis as your body shifts to accommodate your little one. What can I do to relieve SPD Living with SPD can be uncomfortable at best, so you may be wondering what you can do to help alleviate some pain. Being fit before pregnancy can help, as stronger glute and abdominal muscles can help support your pelvis. Physiotherapy can help manage SPD pain, as a physio will be able to work with you as your pregnancy and pain levels change. Speak to your doctor first, as they may have recommendations for you. Your pelvis should return to normal between 4 and 12 weeks after birth
As a new mom, the birth of your baby is a beautiful and exciting time, but there is a darker side to childbirth. Postpartum depression affects about 15% of moms after delivery, and while it is a serious disorder it can be overcome through treatment. What is Postpartum depression? Feelings of anxiety, sadness and fatigue are common after birth and are often referred to as the ‘baby blues’ and should subside within the first two weeks. However, if these feelings stick around for longer, you could be experiencing postpartum depression. Restlessness, mood swings, insomnia, irritability, disconnection from your baby and feeling of worthlessness are all red flags for postpartum depression. Some moms feel guilty or ashamed to be feeling this way, however PPD can affect any woman. Don’t be afraid to reach out for help, as PDD is treatable through both medicated and unmedicated options. What should I do if I have the symptoms of Postpartum Depression? The good news is that PPD is treatable. There are a variety of common types of treatment, which depend on the type and severity of symptoms. Treatment can include counselling, therapy groups, antidepressants and hormone therapy. Self-help groups can be helpful, as it allows you to connect with others who have experienced similar problems and stop feelings of isolation. Recovery time will also vary from mother to mother, but untreated the disorder will last much longer and can interrupt mother-child bonding. Getting help does not mean you are a bad mother, it is important to reach out if you are feeling depressed. Postpartum Psychosis In rare cases moms can develop postpartum psychosis. This should be treated as a medical emergency, and it is essential that you receive help right away. Symptoms include paranoia, delusion and erratic/disorganised behaviour. How to deal with mental health after pregnancy Your mental health is critical to you and your child’s well-being. If you are worried about PPD it is important to get professional help. However, you can help your mood by slowly getting back into exercise, setting aside time for yourself and leaning on those around you for support. It is important to stay connected to family and friends so that you don’t feel alone.
Traditionally, medical aid schemes implement fee increases from 1 January every year. However, the last two years have seen new trends emerge because of the Covid-19 pandemic. These include deferral of increases, dipping into reserves to reduce increases and announcing delayed increases above CPI. What does this mean for consumers? Globally people are feeling the financial pinch and South Africa is no different. High inflation has increased the cost of food, fuel and utilities. Salary increases, if any, are below CPI and many South Africans have lost their jobs. More so than ever, everyone is looking for value for money and better benefits, especially when it comes to healthcare. The balancing act Lee Callakoppen, Principal Officer of Bonitas Medical Fund says, ‘the delicate balancing act between maintaining the sustainability of the Scheme, while ensuring our members have access to affordable, quality healthcare is a core focus. Last year, we were the only Scheme to announce a 0% increase on one of our plans – the BonFit option. This was followed by the industry’s first ever reduction in a premium of 7,9% on our BonStart Plan in 2022.’ What using reserves meant for members ‘We opted to utilise around 3.2% – or R600 million – of the Scheme’s reserves to help limit contribution increases to below CPI for around 82% of our members for 2022. Contribution increases would have been closer to pre-pandemic levels of CPI + 4% if we had opted not to use some of our reserves. Deferred increases vs using reserves This move was in line with the Council of Medical Schemes (CMS) Circular 42 of 2021 which suggested the utilisation of reserves to cushion members against increasing costs. However, despite the guidelines, several schemes opted to defer increases from January to later in the year. These deferred increases range from 5.5 to 7.9%. In general, medical schemes need to keep their contribution increases as close to the rate at which the cost of providing healthcare escalates. The challenge is that most healthcare costs in South Africa are not regulated, which means providers are free to charge as they see fit. And the consumer bears the brunt. An example is the cost of Covid-19 PCR tests, which was finally standardised earlier this year. Consumers in for a rough ride Statistics SA cited CPI at 5,9% in December 2021, 0,4% higher than the month before. This trend is expected to continue with National Treasury projecting headline inflation (the change in CPI) at 4.8% in 2022 and 4.4% in 2023. So, consumers are in for tougher times. Is there freedom to change schemes with deferment? Callakoppen explains that the deferment of increases creates an anomaly for companies, medical scheme members and consumers. ‘Traditionally, members are free to change their options once a year during an open period. However, when a deferred increase arises, this open period does not always come with it. This complicates matters for companies which allow their staff to choose between various medical schemes. If an employee chooses to stay with a scheme offering a deferred increase, it is difficult and sometimes impossible, to switch to another plan. This is compounded by the fact that when these deferred increases take place – they are often above CPI and do not always include an increase in benefits – so members effectively pay more for less. Know what you are getting ‘By announcing our contribution increases in January, our members know what they will be paying for their medical aid from the outset of the year. This means they can plan and, if necessary, adjust their options accordingly to suit both their healthcare needs and their budgets. With the scenario of deferred increases, our advice is for companies to consider a mid-year open period to allow employees to change schemes or options to benefit already cash-strapped employees,” he added. The downside of deferred increases The past year has shown that the actual contribution increases experienced by members, after the deferment period, is typically higher than the industry average. An example is a Scheme that offered a contribution deferment for the first 6 months of 2021 but then applied a 5.9% contribution increase, when the industry average was 4.6%. Contribution increase percentages cannot be looked at in isolation without looking at the Rand value of the contribution. “Based on our analysis, we feel that a deferment strategy is not ideal. It merely utilises scheme reserves to provide a short-term contribution relief to members who subsequently experience an above market related contribution increase. This results in members being worse off compared to the scheme that applied a lower, market related contribution increase from the beginning of the year. Schemes implementing a contribution deferment are already applying above market average contribution increases. Callakoppen says that no matter whether a scheme has chosen to increase contributions or defer them, South Africans need to make sure they get the healthcare cover they need. “No two people or families are alike, medical needs differ, as do finances which is why you need to get cover that suits your health needs and budget. It’s important to interrogate what is being offered, to understand what is covered and any added benefits being offered which won’t impact your savings, before finalising your decision.”
Gestational hypertension is high blood pressure (the pressure of your blood on the walls of your blood vessels) during the later part of pregnancy, as opposed to chronic hypertension which is high blood pressure outside of pregnancy. Hypertension affects about 6 – 8 % of pregnant women, and unfortunately can negatively affect you and your baby. How will I know if I have gestational hypertension? You are more at risk if you’re carrying twins, are overweight, had high blood pressure, kidney disease or diabetes before becoming pregnant or are older than 40 or younger than 20.Gestational hypertension is high blood pressure in the second half of pregnancy and some moms may not even realise that they have it – which is why regular check ups are important. Unfortunately, high blood pressure during pregnancy can develop into preeclampsia. If left untreated, preeclampsia can lead to serious complications and even death. The most effective treatment of this is delivery of your baby (if possible). Symptoms of preeclampsia include headaches, nausea and excessive protein in your urine, with the most common first sign being a rise in blood pressure. How can I avoid or treat hypertension? Although there isn’t anything you can do to prevent hypertension(some variables such as age and number of babies you’re carrying is uncontrollable), you can try to keep yourself (and your baby) as healthy as possible during your pregnancy to help you control your blood pressure. Knowing your blood pressure level before getting pregnant, reducing your salt intake and regular exercise are all things you can do to help stay healthy and aware of your body’s condition. Going for regular checkups during your pregnancy will also help let you catch any problems early.
Obesity is one of the biggest health challenges facing the world today, affecting around 800 million people, with millions more at risk. The prevalence of obesity has tripled over the past four decades, imposing an enormous burden on people’s health as well as the healthcare system. According to a World Health Organization (WHO) report, more than a quarter of South Africans live with obesity, making the country among the top 20% of the most obese nations in the world! Studies by the SA Medical Research Council indicate that nearly half of all South Africans are overweight. Even more shocking, is the fact that 22% of children between 1 and 9 are overweight or obese. The pandemic, lockdown and increased sedentary lifestyle has made the situation worse Dr Morgan Mkhatshwa,Head of Operations at Bonitas Medical Fund says, for overweight or obese people it’s not just an issue of vanity or fitting into a pair of jeans. ‘Risks associated with obesity include: Significantly contributing to the development of cardiovascular disease, type 2 diabetes, hypertension (high blood pressure), cancer (particularly colon, prostate and breast), sleep apnoea, degenerative joint disease, digestive tract diseases (gallstones), mental health and dermatological disorders. What determines if you are obese or not? Your Body Mass Indicator (BMI) calculator checks if you’re at a healthy weight. Here’s how to calculate yours: Divide your weight in kilograms (kg) by your height in metres (m²) If your BMI is over 25 you are considered overweight, at 30+ you’re classified as obese. There are detractors of BMI on its own The BMI screening may not be the best option for bulky, body-builder or stocky men for example. This is because it does not distinguish between lean muscle mass and body fat. Best practice is to measure body fat percentage along with the BMI calculation. This provides a better indication of one’s body composition. ‘Obesity is a chronic and progressive disease,’ says Dr Mkhatshwa,‘Urbanisation and the lifestyle associated with it, is one of the main contributing factors.’ There are two reasons for this: Lack of exercise: Cities are often over-populated, there are too few public spaces for physical activity and many residents use transport to commute Poor nutrition. Changes in diet include more processed and refined food, an increase in high-fat and high-sugar diets, less fruit and vegetables, less complex carbohydrates and fibre Although obesity is often associated with poor lifestyle choices, lack of motivation or unhealthy habits – it isn’t always the case. In America, where 40% of adults are obese, obesity has been recognised as a disease by the American Medical Association for nearly a decade. Despite this, they are still seeing most treatment approaches for obesity focus solely on behavioural therapy. The stigma and assumptions like this continue to create barriers that have limited better obesity care. The origin of obesity is complex and poorly understood, but includes nutritional, physiological, psychological and genetic factors. Environmental factors such as a sedentary lifestyle and excess calorie consumption can cause obesity Genetic studies with adopted children have demonstrated that they have similar BMIs to their biologic parents but not their adoptive parents. Twin studies also demonstrate a genetic influence on BMI Secondary causes of obesity can result from medications (eg. antipsychotics, steroids and anti-viral drugs) and endocrine disorders like Cushing’s syndrome and hypothyroidism According to the International Journal of Obesity, adults with obesity (BMI ≥ 30) incur 42% higher medical costs per capita and are nearly two times more likely to die before age 70 than adults with a healthy weight. They also say that health care providers play a vital role in the prevention, treatment and control of obesity. They recommend that multicomponent behavioural interventions, pharmacotherapy and bariatric (stomach shrinking) surgery are all effective strategies that support clinically significant weight loss. Obesity as with other co-morbidities, was also a poor prognostic factor for Covid-19 hospitalisations The general consensus regarding self-monitoring though is through: Calorie restriction: Reducing your intake by 500-1000 kcal per day will reduce total body weight by an average of 8% over a year Exercise: 30 minutes a day will yield health benefits, but 60 – 80 minutes will assist in weight loss and additional benefits Behaviour modification: Goal setting, self-monitoring and modification of one’s environment to enhance behaviours that will support weight management ‘The reality’, says Dr Mkhatshwa, ‘is that obesity and concomitant lifestyle diseases have become a pandemic in South Africa. Diabetes 2 is amongst these and has significant health implications. Managing this disease is imperative. We offer a diabetes management programme to help people understand this long-term condition and empower them to make the right decisions to stay healthy. This includes access to specialised diabetes doctors, dieticians, podiatrists and diabetic educators to effectively manage of diabetes. However, if you are not on a medical aid, there are several diabetic support groups.’ ‘Everybody needs to act’. It’s time to increase awareness of the root causes of obesity and encourage advocacy for change.
In July 2019, the Minister of Health published a draft ‘National Health Insurance Bill’, which attracted a great deal of attention and the scrutiny hasn’t stopped. Despite several engagements, the Department of Health (DoH) has failed to provide clarity or explanations on several key issues within the ‘Bill’, which are of major concern to all stakeholders. ‘That fact that universal healthcare is desperately needed in South Africa is not being debated. Having only around 16% of the population on private medical aid, with the rest relying on public health, is unsustainable,’ says Lee Callakoppen, Principal Officer of Bonitas Medical Fund. ‘What is worrying is the lack of detail around the implementation of this national health blueprint. Before discussing concerns about the implementation of NHI, we should discuss the ramifications of curtailing the role of medical aids. Medical aids and associated services make an enormous contribution to the annual fiscus. The industry also contributes significantly to employment and, in turn, to the economy of the country. Healthcare administration is a massive undertaking that requires, skills, experience and expertise. State of the art technology is needed to comply with international best practices. South Africa’s medical administrators are world class, it is simply not feasible to consider having one administrator in charge of the healthcare of millions of South Africans. Private healthcare is also a source of excellence in terms of innovation and development, which benefits the public sector. This essential role of private healthcare will be strangled if it is not able to continue in a private setting. A few additional concerning NHI issues include: Funding of the NHI There is a proposed health financing system – designed to pool funds – but nowhere has detail been provided on this funding model. When first presented, the estimated cost of NHI was R256 billion, with it due to be rolled out in 2026. It is not known how this figure was reached. The Institute of Race Relations (IRR) recently stated that NHI is likely to cost around R700 billion a year when fully operational in 2026, as the government now envisages. According to the IRR, ‘The increased tax burden will fall particularly heavily on the 700 000-odd individual taxpayers who currently pay about two thirds of all personal income tax and a hefty chunk of VAT’. What will NHI offer? The Bill defines ‘comprehensive health care services’ as: Healthcare services that are managed to ensure a continuum of health promotion, disease prevention, diagnosis, treatment and management, rehabilitation and palliative care services across the different levels and sites of care within the health system in accordance with the needs of users. However, no further indication of the details of these services / benefits is provided except to indicate that medical schemes will offer what is referred to as ‘complementary cover’. This is defined as third party payment for personal healthcare service benefits, not reimbursed by the Fund, including any top up cover offered by medical schemes or any other private health insurance fund. Single purchaser, single payer? The Bill states that the NHI will serve as the single purchaser and single payer of healthcare services, ie., that there can be no other legal entity that can purchase and pay for healthcare services. This doesn’t distinguish between complementary and duplicative services. Which means it would be illegal for medical schemes (or health insurance firms) to exist, even in a complementary form which contradicts other sections of the Bill. Constitutional rights Bonitas does not agree or support the proposed amendments to the Medical Schemes Act (MSA) as set out in the Bill, we believe allowing medical schemes to provide only complementary cover is unconstitutional. Bonitas does, however, support the healthcare reforms as recommended by the Health Market Inquiry. The Constitution requires the State to protect, respect, promote and fulfil the rights in the Bill of Rights. The State must protect the rights to access that people already have. The right of access to healthcare is much wider than the right to obtain healthcare through the public sector. It includes the right to purchase healthcare from the private sector, if one can afford it. The purchasing power of the consumer is a legitimate means of access to healthcare. Consumers must have the right to apply their purchasing power as they deem fit. The Bill, in its current form, makes it unlawful for people to purchase healthcare services not covered by NHI. The proposed Bill is fraught with illegalities and is in direct conflict with the Medical Schemes Act 31 of 1998 (MSA) and prevailing regulations. The administration of the proposed central system of healthcare will need strict governance as existing medical aids are strictly regulated. Sound corporate governance is of critical importance in preventing mismanagement of assets, corruption, inefficiency, illegality, unethical conduct, abuse of the Fund’s resources and the collapse of the Fund. The way forward The notion of NHI is commendable, but it’s a case of the ‘devil is in the detail’. Detail which is yet to be unpacked and specified. The only way for the healthcare system to evolve is through inter-dependent relationships. Medical schemes should be allowed to assist the NHI administratively and take over some of the risk and burden which would lie with the NHI in respect of members of medical schemes. This would ensure that the funds deployed in the procurement of healthcare services are not unnecessarily exploited through duplication of services and functions. Lee Callakoppen, Principal Officer, Bonitas Medical Fund
