Bonitas – innovation, life stages and quality care

Give your body a leg up – immune boosting

Now more than ever we need to find ways to boost our immune systems as much as possible. And, while there are no medications or immunity-boosting supplements that can cure or prevent the coronavirus, there are some simple lifestyle changes we can make and steps we can take to strengthen our defences. Good nutrition can also reduce developing other health problems including obesity, heart disease, high blood pressure, diabetes, and some types of cancer. Dr Morgan Mkhatshwa, Head of Operations at Bonitas Medical Fund says, ‘Eating a healthy diet, high in immune-boosting nutrients, is just as important during this pandemic. What we eat and drink can affect our body’s ability to prevent and fight disease and recover from it. This is one of the ways in which we can improve our health proactively.’   What is the immune system? The immune system is a complex network of cells and proteins that defends the body against infection. It also keeps a record of every germ (microbe) it has ever defeated, so it can recognise and destroy the microbe quickly if it enters the body again. There is no magic pill that will instantly boost your immune system. However, together with a healthy lifestyle, various supplements can boost your immune system and give you a fighting chance.  Together with those people who have not been vaccinated, it is well documented that people with co-morbidities and poorly functioning immune systems are at the highest risk of getting really ill from Covid-19. Although you cannot suddenly reverse a co-morbidity or instantly boost your immune system, now is a good time to make your health and natural defences a priority.  Tips for maintaining a healthy diet: Eat a variety of food, including wholegrains (like maize, oats, rice, and legumes) as well as plenty of fruit and vegetables in your diet Limit salt intake to 5 grams (a teaspoon) a day Eat moderate amounts of fats and oils. Avoid saturated fat (animal fat). Try steaming instead of frying when cooking Limit sugar intake. This includes sweets, fizzy and sugary drinks. Choose fresh fruit over biscuits, cake, and chocolate Drink water. Good hydration is crucial for good health so make sure you drink enough water. There are many foods with high water content – such as cucumbers and celery – add these or lemon and mint, to a glass of water.  ‘Ideally we should try and get all our vitamins from the food we eat. However, that’s not always possible which is why taking vitamin supplements can help bridge the gap,’ says Dr Mkhatshwa. ‘The recommendation for general health is a combination of essential vitamins and minerals to keep your body healthy.’ Vitamin C: Key to fighting infection is to increase white blood cell production, eating foods high in vitamin C – such as grapefruit, oranges, sweet red pepper, broccoli, strawberries, kale, and tomato juice – are thought to help plus Vitamin C has been shown to reduce the duration and severity of upper respiratory tract infections.  Beta-Carotene: Beta-carotene converts into vitamin A, which is an anti-inflammatory vitamin that can help your antibodies respond to toxins, such as a virus. Beta-carotene is found in carrots, spinach, kale, apricots, sweet potato, apricots, and squash.  Vitamin E: Is an essential antioxidant that helps fight cell damage and supporting immune system function. Foods rich in vitamin E include nuts, peanut butter, seeds, avocado and spinach. Antioxidants: Green tea is packed with antioxidants that have been shown to enhance immune system function. It also contains amino acids that may aid in the production of germ-fighting compounds in your T-cells, which reduces inflammation in the body and helps fight infection.  Vitamin D: This vitamin also fights off infections and maintains strong bones. It is found in salmon, canned tuna, egg yolks, milk, cereals, breads, and mushrooms. Alternatively, make sure you expose your body to 13-15 minutes of sunshine three times a week for a natural Vitamin D fix. Studies have shown that Vitamin D can expedite healing and stall inflammation in the respiratory system but there has not been robust clinical evidence to prove its use against Covid-19. Probiotics: Live cultures, known as probiotics, are said to help stimulate the immune system to fight off disease. Yogurt, Kombucha, Sauerkraut, Kimchi, pickles as well certain types of cheese contain live cultures. Vitamin B-6: Is essential in the formation of new and healthy red blood cells and helps maintain the lymphatic system. Chicken, turkey, cold-water fish (salmon and tuna), chickpeas (traditional hummus), bananas, fortified breakfast cereal and nutritional yeast are great options for consuming vitamin B-6. Zinc: Is a mineral that our body doesn’t store or produce, however our Immune system cells need zinc to function as they are intended, it boosts the metabolism along with healing wounds. Red meat, shellfish, poultry, beans/legumes, and nuts/seeds are high zinc foods.  ‘During this global pandemic we need to understand that our actions are not just to protect ourselves but also those around us,’ says Dr Mkhatshwa. ‘The risk of contracting Covid-19 is higher in crowded spaces so, reiterating what the President said, we need to heed the call to make sure you socialise outdoors or have plenty of fresh air flowing through your homes and workplaces. The World Health Organization talks about avoiding the 3Cs: Spaces that are closed, crowded, or involve close contact. ‘We need to work together to contain the spread of Covid-19 especially during the various mutations of the virus. With the 4th wave upon us, we need to vaccinate, wear masks, keep our distance, follow good hygiene protocols, boost our immune systems and get plenty of exercise and fresh air.’

December 10, 2021
Bonitas – innovation, life stages and quality care

Vaccinations proving to be the best defence

As the fourth wave of Covid spreads, South Africa is seeing a considerable increase in positive cases. Just as the Delta variant became part of our daily vocabulary, the Omicron or BI.I.529 strain has too. Omicron has more than 30 mutations (double those carried by Delta) that may have an impact on how it behaves. This includes how easily it spreads and the severity of the illness it causes. The Omicron variant was found in 74% of the 249 Covid-19 samples that were gene-sequenced in November in SA. It appears with more than double the mutations carried by Delta, Omicron is virulent enough to take over from Delta. Current international data shows that there are far more positive cases, meaning that Omicron appears to be highly transmissible. However, although more people are testing positive, they are presenting with mild symptoms with fewer hospital admissions. Medical professionals believe this is a direct result of the immunity acquired through vaccinations. The first wave of Covid-19 took the world by surprise but globally everyone is better prepared for this new wave. This includes a sustained effort to vaccinate as many people as possible. What the World Health Organization (WHO), the National Institute for Communicable Diseases (NICD) and most people involved in the healthcare sector agree on unanimously, is that the best form of protection from serious disease is vaccination.  Lee Callakoppen, Principal Officer, Bonitas Medical Fund says, “We have been proactive in urging our members and the public to be vaccinated. Our statistics show that, of our members over 60, there are 90% fewer admissions to hospital after full vaccination and 56% fewer after one vaccination. Research across the public healthcare environment has shown the same results. With this information freely available it is disturbing that only 16 944 413 people living in SA have been vaccinated. This is only 35.5% of adults and 23.7% of the total population. ‘The cost of hospital admissions too, especially ICU, are very high. Our figures show that up to November 22, the Bonitas Covid-19 costs totalled R1.75 billion. 80% of this (R1 399 181 922) was hospital costs, while only 4.9% (R85 669 068) was for vaccinations.  ‘The average cost of admission to ICU, per patient, was R533 969. There is no doubt that vaccinations not only save lives but also reduce the burden on the public healthcare system, as well as save the country billions in costs related to treating Covid. Vaccinations are a fraction of the cost of treating Covid.’ Both in the public and private sector, the unvaccinated are filling our hospitals. Dr Waasila Jassat, from NICD, announced at the end of November that ‘unvaccinated patients suffered more severe symptoms than vaccinated ones and were most likely to face hospitalisation if infected by the new Covid-19 variant.’  She said that 90% of patients admitted to hospital in Pretoria (one of the current hotspots) are unvaccinated. ‘Not only is there a higher incidence of hospital admissions but also that the chances of death amongst unvaccinated are considerably higher.’ Callakoppen says there is enough clinical evidence to show that the vaccination reduces the severity of Covid and he encourages everyone to be vaccinated. He urges those who have been vaccinated to encourage others to do the same. However, this doesn’t mean you can forgo following the Covid protocols: Wearing a mask; sanitising your hands, maintaining social distancing; staying in well ventilated spaces; coughing or sneezing into your elbow or a tissue. Bonitas has reported the following Covid related figures for 2021 as of 22 November. Total lives older than 18 estimated to have received at least 1 jab 66.4% Total tests performed:  441 929 Total Covid-19 hospital admissions: 20 376. (12 264 during 2021) Bonitas lives currently in hospital: 0.3% Admission rate: 25% ICU Admission Rate: 22% Total Covid deaths: 3 515 (2 292 in 2021)  Total Bonitas membership vaccinated: 70% Highest number of people vaccinated is in the 35-49 age group followed by the over 60s ‘I must reiterate that our best defence against Covid-19 is to be vaccinated,’ says Callakoppen. ‘It won’t necessarily stop you from getting the coronavirus but it will reduce the severity of the disease. I contracted Covid in September but thankfully because I was fully vaccinated, my symptoms were mild which meant I was able to heal and recover at home. My experience is not unique.’   Dr Morgan Mkhatshwa, Head of Operations at Bonitas Medical Fund answers some common questions around Omicron What is it? It’s a new, heavily mutated Covid variant known as BI.I.529. When was Omicron first detected? The earliest sample was detected on 11 November in Botswana. Is it more transmissible? Circumstantial evidence indicates it is. Within two weeks of its detection, it has outpaced Delta to become the main strain in Gauteng. Will vaccines work against it? Yes, most likely. A crucial objective remains to increase vaccination rates. Current vaccines remain critical to reducing severe disease, hospitalisation and death. Should updated vaccines be developed, they will be rolled out globally and used as guided by WHO. Will prior infection provide me with immunity? Preliminary evidence suggests there may be an increased risk of reinfection with Omicron but information is limited. More information on this will become available in the coming days and weeks. What about treatment? Currently Oxygen and Dexamethasone have been saving lives. There is however very exciting data coming from two antivirals. What about the current tests? The widely used PCR tests continue to be the global standard to detect infection including Omicron. Studies are ongoing to determine whether there is any impact on other types of tests including rapid antigen tests.

December 7, 2021
Bonitas – innovation, life stages and quality care

Medical aids can’t bear the brunt of hospital increases

Hospital admissions are one of the biggest cost drivers for any private medical scheme which is why the tariffs are under review and negotiated annually by Bonitas Medical Fund. If no agreement is reached, medical aid members will bear the brunt of high co-payments. According to Lee Callakoppen, Principal Officer of Bonitas Medical Fund, hospital admissions account for half of the Scheme’s annual claims cost. ‘Last year due to the pandemic, hospital admissions and the utilisation of other medical aid benefits fell to record lows. However, the 2021 claims’ experience has shown that a lot of services, particularly the day-to-day benefits and several hospital admission categories, are already close to 2019 levels.  Since the start of the pandemic Bonitas has spent more than R2,7bn on COVID-19 related costs, of which R1,73bn pertain to 2021 year-to-date. More than 80% of these COVID-19 costs relate to hospitalisation. Non-COVID utilisation patterns are almost back to typical levels and, since June this year, overall claim ratios have returned to pre-COVID levels. Schemes are therefore not generating the same level of short-term surpluses in 2021 as was seen in 2020. ‘We anticipate that during 2022, utilisation is going to go back to where it was in 2019 or even higher. Which is why it is critical that schemes, such as Bonitas and hospital groups, through an annual negotiation process agree fair and equitable tariff charges, to ensure the lowest possible increases in the interest of members. This will not only help keep costs down but also ensure quality and affordable healthcare for current and future members, while maintaining the sustainability of schemes. We must acknowledge that over the last three years concerted efforts have been made by hospital groups to support and keep tariffs low. However, there are still significant opportunities to drive healthcare cost down. ‘We know that all sectors had been hard hit by the pandemic and the poor economic outlook in this country. Healthcare and medical schemes are no exception. However, we need to remain mindful that key to the survival of the private medical aid industry is its members. If hospital costs balloon above CPI, so will membership premiums, which will result in medical aid becoming unaffordable. We are appealing to all our service providers, including hospital groups, not to pass their costs on to schemes and, by extension, to members.  The pandemic saw healthcare facilities and healthcare providers intensify their efforts to ensure that South Africans received the appropriate care for Covid-19 as far as possible. And while their efforts have been lauded, consumers have had to contend with tough conditions as well.  Moving into 2022 There are major concerns about 2022 utilisation levels, notably due to the risk of an increased burden of disease due to gaps in care that may have arisen during the pandemic, which is no fault of any party. We anticipate an elective procedure claims catch-up after so many were cancelled in 2020 and 2021 during national lockdowns. Other areas of concern include the unknown impact of long-haul COVID as well as new or more expensive COVID-19 treatment costs, including booster vaccines, which may emerge,  All stakeholders in the healthcare value chain need to be prudent in managing their costs of doing business. The intention of negotiated hospital tariffs is to reach an agreement that supports sustainability of the healthcare ecosystem and, ultimately, members. The issue comes when there is no agreement reached and members may have to pay in the difference between what the hospitals charge versus what the scheme is able to pay. We try to avoid such a situation so as not to have a negative member impact, but if parties are unreasonable in their demands, this situation may arise.’ To assist our members and reduce the effect of significant contribution increases for 2022, Bonitas used R600m of its reserves to keep increases as low as possible. Contribution increases were kept below 5% for both 2021 and 2022 despite underlying claims expenditure increasing by a significantly higher margin. Bonitas’ medium-term objective is to sustain solvency levels above the statutory minimum of 25% and to make strategic decisions about current reserves in the interests of its members. This while facing significant uncertainty, especially in terms of the cost and prolonged impact of COVID-19, non-COVID-19 utilisation and roll-out of vaccines. All non-healthcare costs are capped below CPI for 2022.  However, if healthcare providers and hospital groups do not negotiate favourable tariffs for the year ahead, it results in higher increases in the long run, for all patients and unnecessary out of pocket costs.  The benefits of negotiations Negotiations resulted in a 3.1% saving in 2021 terms – these savings could exceed R200 million in 2021 – while in 2020 strategic purchasing yielded hospital negotiation savings of R346 million. These savings contribute to a lower contribution increase. The impact of failed negotiations However, when the costs of doing business is passed on to schemes and, by extension, customers – or medical aid members – things become complicated, especially where tariff increases agreements cannot be reached.  In these instances, there are two possible scenarios: A scheme pays what it deems to be a reasonable rate and the hospital bills its rate. This means the member would be required to pay in the shortfall on the account unless the hospital decides to override the difference A scheme excludes the hospital from on its network and actively discourages a member from using this hospital. The member may need to pay a deductible or co-payment if they choose to be admitted at this facility unless the hospital decides to override the difference. ‘Neither of these situations is a favourable outcome,’ says Callakoppen. ‘Which is why reaching a workable middle ground on hospital cost/tariffs is imperative.’

November 17, 2021
Parenting Hub

Walking the road to wellness

Being healthy and living a full life is what we all want, for ourselves and our family.  An important part of life’s wellness journey is about having the right people to support you – physically, emotionally, mentally and even financially – when it matters most. The latest television ad by Bonitas Medical Fund underpins this ‘holistic’ healthcare message in a simple, real and compelling way. It addresses the fact that medical aid is a necessity but expands on the message to show how the Scheme acts in the best interests of its members and ‘has a plan’ for everyone.  The story is one of perseverance and tenacity as a father tackles his tough wellness journey with the support of his family, friends – and medical aid – in order to walk his daughter down the aisle. ‘The story is about protecting our loved ones and making sure they have the best care possible,’ says Lee Callakoppen, Principal Officer of Bonitas. Produced by Joe Public and shot over three days in various locations, the advert reinforces the Bonitas’ brand strategy of being the ‘Medical Aid for South Africa’ while it introduces a campaign takeout referencing affordable and accessible quality healthcare and better benefits that don’t impact your savings. ‘We are a unique medical scheme,’ explains Callakoppen. ‘In that we offer medical aid solutions for all sectors of the market and the South African population. Our advertising needs to be slightly disruptive and set us apart, which is why we chose to portray a real life family dealing with a healthcare situation that was impacting their lives and future.  ‘We’re always taking strides to see how we can provide our members with more value – and connect with them more strongly. Be it through competitive plan design, the introduction of new benefits that add meaning to their lives or innovation in the way we communicate and engage with them.’ There are several versions of the ad including a 60s, 30s and three 10s which will be flighted across a range of DStv channels as well as Business Day TV, ENCA, eTV and SABC. Supporting the campaign will be radio, print and digital adverts. ‘We are passionate about ensuring South Africans make informed decisions about their healthcare and that they have the cover they need, when they need it. Our hope is that this TV advert will resonate well with viewers and get them thinking about the future of their health.  We believe ‘when I becomes we, illness becomes wellness’ and would like to be the medical aid that takes the wellness journey with them.’ Click here to view the latest Bonitas Medical Fund TV advert

November 10, 2021
Bonitas – innovation, life stages and quality care

Keeping kids healthy throughout the year

Parents are often very good about getting their children off to a healthy start at the beginning of the year with medical check-ups and healthier schools lunches but it’s equally important to maintain a healthy lifestyle throughout the year. So, here are some tips on what you should be doing to maintain your child’s health.

November 8, 2021
Bonitas – innovation, life stages and quality care

Keep your kids moving

Winter is here and with it comes colder weather, making getting outside to play and exercise more of a challenge. But it’s still important. Bonitas Medical Fund suggests you try and keep your child active throughout the year and provides some suggestions to get them moving, exercising and having fun.

November 1, 2021
Bonitas – innovation, life stages and quality care

Home-based care – there is no place like home

The shift towards home-based care was accelerated by the Covid pandemic. Although not necessarily always possible for Covid patients, the benefits of home-based care vs hospitalisation have been highlighted for both patients and their families for several procedures and illnesses.  Dr Morgan Mkhatshwa, Head of Operations at Bonitas Medical Fund, says the Scheme has a renewed focus on home-based as an alternative to in-hospital care, without compromising the health of its members.  What is home-based care? It’s defined as the provision of health services, by healthcare practitioners and formal and informal caregivers, in the home. Home-based care is to promote, restore and maintain a patient’s maximum level of comfort, function and health, including care towards a dignified death. It can be classified into preventive, promotive, therapeutic, rehabilitative, long-term maintenance and palliative care categories. When is home-based care appropriate? Post-operative care – after a surgery or procedure so that you gain your independence and become as self-sufficient as possible Generalised illness – when you are ill enough to be admitted to hospital but can be treated at home by healthcare practitioners Palliative care – when you have life-limiting illnesses and the focus is on the relief of symptoms, pain and stress. Some patients may also receive therapeutic treatment.  The primary benefit of home care is that you are in a space which is familiar and usually surrounded by loved ones. This is beneficial not only for those recovering from a disease or needing palliative care but especially those who have cognitive diseases such as dementia.   The alternative to hospital strategy (ATH) Dr Mkhatshwa says, ‘Hospital-at-home enables some patients who need acute-level care to receive care in their homes, rather than in a hospital. This care delivery model has shown to reduce costs, improve outcomes and enhance the patient experience. The need for home-based care is not only because of the cost of hospital care but a shortage of beds, nursing staff and other healthcare professionals, particularly in the public sector.’   ‘Bonitas is constantly looking for ways in which to minimise contributions and add value for members.  It is common knowledge that hospitalisation costs are the main cost driver for all medical schemes. Even with 24-hour professional care at home the costs are far less. Most medical aids will pay for nursing care at home For this reason, Bonitas’ partnered with Quro Medical, an innovative South African digital health company, to provide patients with active treatment by healthcare practitioners at home. The technology-enabled hospital-at-home service brings all the essential elements of in-hospital care to the patients’ home, without moving away from evidence-based protocols and state-of-the-art vital sign monitoring. Patients are monitored wirelessly, automatically and continuously to enable early identification of significant clinical change or deterioration. In fact, research has shown that, ‘patients admitted in the home programme were less likely to return to the hospital within 30 days of their discharge’. ‘The partnership also offers earlier and safer relocation to the home,’ says Dr Mkhatshwa’ home-based care is offered to all members, subject to pre-authorisation and Managed Care protocols. ‘It’s important to note that the treating doctor remains at the centre of the patient’s care. While patients who are medically stable may qualify for home-based care, each and every one is different and their response to hospitalisation and/or surgery differs. This means each request has to be reviewed carefully to ensure we provide quality care to deliver the best possible health outcome for the patient.’ The advantages of home-based care Health care at home, in a comfortable environment, improves patient participation in treatment. Having family members and loved ones participating in the care of a loved one – such as helping with bathing, feeding – makes a significant difference in the outcome.  Personal attention Hospitals, out of necessity, have strict rules so instead of the patient adjusting to these, they can be at home, amongst family and in familiar surroundings.  Nursing sisters or carers come to the home for a few hours a day, full time or when the need arises There are no visiting hours and the patient is the primary focus of the caregiver, so needs are met faster and more time is spent with patients.   This also means a faster recovery and the chances of picking up an infection, which can happen in hospital when they are exposed to germs, is reduced. Independence and companionship Losing independence is always a huge concern for those chronically ill or the elderly.  Having home-based care means they have more control and can decide when they want to eat, drink, socialise and sleep.   Companionship A caregiver provides your loved one with a familiar face, friendly conversation and a meaningful human connection, all of which can have a big impact on overall health and well-being. Family involvement Home care enables the family to play a larger part in their loved one’s care plan, this includes a direct line of communication with the caregiver and a care manager providing frequent updates regarding care. Pets It is common knowledge that pets are beneficial to those who are vulnerable and home-based care means pets can stay with their owners. They help calm dementia patients, reducing heart disease and stress related conditions and generally make patients happier.  What about home-based care for COVID-19 For patients with mild disease, home management may be possible, provided they are not at high risk of deterioration (i.e., older than 65 years or presence of co-morbidities). Dr Mkhatshwa says, ‘It must be stressed that while hospital care is indispensable for patients in critical condition, home health care is equally right for thousands of people. This personal approach to treatment gives patients the confidence they need to lead independent, full lives. We have no doubt that this is going to play a key role in the future of healthcare.’

October 13, 2021
Bonitas – innovation, life stages and quality care

Hospital pre-authorisation vs quotes – what you need to know

Due to the different waves of Covid-19 and the emerging variants, a number of elective surgeries were postponed to help minimise the take up of hospital beds and to avoid unnecessary exposure to the virus.  However, surgeries are now getting back on track, – even if it’s only a window during which the backlog of elective surgeries can be tackled. It is the perfect time to talk about the issue of pre-authorisation and quotes and why you should know the difference.  Lee Callakoppen, Principal Officer of Bonitas Medical Aid, says pre-authorisation, ahead of any medical procedure or hospital admission, is always required. He also stresses the importance of asking for a quote to submit to your medical aid. This will ensure you know exactly what is covered and whether you should plan for any out-of-pocket expenses. Does pre-authorisation mean payment, in full, is guaranteed? Not necessarily.  Let’s take you through the process and T&Cs.  What is pre-authorisation? All procedures that take place in a hospital must be pre-authorised.  Essentially, it’s an agreement between the medical aid and the hospital, indicating a willingness to pay for costs associated with the visit. But even if you do have pre-authorisation your medical aid is not promising to cover 100% of the costs.   All pre-authorisation requests are evaluated against the different schemes’ rules and clinical funding policies however, you remain responsible for any shortfall, including any co-payments. If you are unsure how to go about the process speak to your broker or your medical aid.  When do I need to pre-authorise? You must apply for a Pre-Authorisation Reference number (PAR) as soon as a visit or admission to a hospital is planned. This applies for a CT scan, MRI scan or radio-isotope study. Do this as early as possible in case you are required to submit additional documentation or a motivation from your healthcare provider.  You also need pre-authorisation for: Renal clinic admissions for dialysis Procedures in doctor’s rooms or day clinics, instead of hospital Physical rehabilitation care in rehabilitation facilities Drug and alcohol rehabilitation care in specific facilities Hospice admissions Oxygen therapy at home All specialised radiology What information is needed? Name and surname of the person having the procedure Membership number and dependent code The date of admission or procedure The diagnosis All proposed surgical procedures, diagnostic procedures or specialised radiology codes available (ICD-10, CPT, NRPL codes) The name of the facility where the procedure will take place The names and practice numbers of the healthcare professionals (doctor, surgeon, specialist etc)  Once your pre-authorisation has been approved you will receive a confirmation letter. Read this carefully and check that the information is correct. If you are any queries speak to your doctor or your medical scheme.  What about emergency admissions? In the event of emergency treatment or admission to hospital, you – or a family member or the hospital – must contact your medial aid on the first working day after the incident to obtain authorisation.  Did you know? Your doctor or the facility you are being admitted to, can do the authorisation on your behalf. Despite this, it remains your responsibility to ensure that the authorisation is completed and correct.  What happens if you don’t pre-authorise?   You will either be liable for a co-payment, or your procedure will not be covered. Does pre-authorising ensure payment of the procedure? No, unfortunately not.  Most medical aid plans have varying hospital benefits according to the level of cover you have chosen and they also have a ‘rate’ and which they reimburse healthcare providers. This means that even if the payment is 100% of the rate, this is not necessarily what the healthcare provider will charge, they may charge 200% of your medical aid rate. This means you are responsible for any shortfall in the form of a co-payment.  Co-payments differ from one medical scheme to another and are often higher than anticipated, mostly due to medical practitioners and hospitals charging higher than the medical aid rate. ‘We mitigate this as much as possible,’ says Callakoppen, ‘by negotiating with hospitals and service providers who are on our network, to place a ceiling on the costs of the procedures.’ For this reason, it is best to find a healthcare provider on your scheme’s network Quotes vs pre-authorisation for procedures Callakoppen advises private medical aid members to not only obtain pre-authorisation but to also ask for a detailed quote from the hospital and medical practitioner prior to being admitted to hospital.  ‘This gives you an opportunity to negotiate and eliminates any additional ‘surprise’ payments required after the procedure. ‘The most important thing’, says Callakoppen, ‘is to find out, prior to being admitted, what your medical aid will pay and what payment you might be responsible for. The last thing you want to deal with is a surprise large co-payment and the stress related to that when you are recovering from a procedure.’ 

September 30, 2021
Bonitas – innovation, life stages and quality care

What should I do if I have symptoms of COVID-19 and I am pregnant?

Given today’s current global COVID-19 pandemic, worrying about the potentially harmful viruses’ effect on your pregnancy and baby is a valid concern. You’re probably wondering the best ways to avoid the virus when pregnant, and what to do if you think you may have caught it. How can I protect myself and my baby from catching the corona virus? Protecting yourself from COVID-19 while pregnant, is similar to that of anyone else avoiding the virus. Minimise contact with others through social distancing, frequently wash and sanitise your hands, and avoid touching your nose, eyes and mouth. Don’t be tempted to skip important prenatal visits in lieu of avoiding the virus – chat to your doctor about the best way forward with regard to this. Although slightly disappointing, cancelling events such as baby showers is a good idea, as the risk of exposure and infection becomes bigger with larger groups. Being pregnant, it’s a good idea to be extra precautious where possible. However, the RCOG (Royal College of Obstetricians and Gynaecologists) states that pregnancy doesn’t increase your risk of becoming unwell from coronavirus, and the majority only develop mild to moderate symptoms. What should I do if I think I have COVID-19 while pregnant? If you think you may have COVID-19 or have tested positive for corona the first thing you should do is contact your doctor. However, it’s best to avoid travelling to the doctors office as you may come into contact with someone positive for COVID-19 in these spaces. As the virus is new, this means that the studies that have been conducted are limited. Because of this it’s essential to follow social distancing guidelines to try and protect yourself, however, if you do contract the virus there is no immediate need for stress, as pregnancy doesn’t increase your risk.

September 23, 2021
Bonitas – innovation, life stages and quality care

Redefining healthcare in 2022

As South Africa moves to Covid-19 adjusted Level 2 and vaccination numbers increase, access to quality healthcare remains a priority.  Today, Bonitas Medical Fund announced its 2022 product line up offering. This includes the use of reserves to keep contribution increases lower, a Benefit Booster to stretch day-to-day benefits, a revised international travel benefit with payment for Covid tests and a contribution towards quarantine costs. There is also a renewed focus on preventative care, virtual consultations and plans that enable more South Africans to have access to affordable, quality healthcare.  Lee Callakoppen, Principal Officer of Bonitas said, ‘The Scheme performed well in a volatile market, attributable to proactive risk management and prudent board decisions. A positive offshoot of the pandemic was an increased appreciation of medical aid cover that resulted in better-than-expected member retention and a 2.3% membership growth since January.’ Top line changes ’We have taken a strategic decision to utilise approximately R600m of reserves to ensure that 82% of members receive a below CPI contribution increase for the 2022 benefit year. The innovative Benefit Booster equates to an increase in day-to-day benefits for members ranging from 16% to 32%, depending on the members’ plan. We believe it is the largest increase in benefits ever seen in the medical aid industry.’  The average weighted contribution increase across all plans is 4.8% with the BonStart premium decreasing by 7.9%, which can be attributed to the low cost versus benefits ratio and the younger membership profile on the plan. The decrease in contribution is an industry first – as was the decision to offer BonFit Select at a 0% increase in 2020. New offerings include an additional virtual plan, BonStart Plus, a renewed focus on Managed Care with an oncology management programme as well as an enhanced member app, powered by AMP, which includes a personalised wellness programme to encourage healthier behaviour. Plans There will be a total of 15 plans for the year ahead comprising traditional, savings, hospital, edge (virtual), network and income-based plans, each carefully crafted with a specific mix of benefits to appeal to various target markets. Increases range from minus -7.9% to 6.5%. Bonitas has opted to increase its options which are currently in a growth phase – BonSave, BonFit and BonEssential – by only 3.6%. Sustainability and affordability The Council for Medical Schemes (CMS) recommended increases in line with CPI of 4.2% with the caveat that financial stability and sustainability of schemes must remain a priority. We feel that the use of part of our reserves to cushion members against increasing costs is an appropriate strategy. Other recommendations by the CMS include: Driving innovation from a pricing point of view; exercising caution in terms of utilising reserves to help cushion increases and adopting innovative pricing models – a directive Bonitas took to heart. Boosting benefits The Benefit Booster is the most innovative change in the healthcare industry since the advent of the savings account. It stretches value and equates to an increase in day-to-day benefits ranging from 16% to 100%, depending on the plan. This covers all out-of-hospital claims including acute medicine, GP consultations and non-surgical procedures such as wart removal. Members simply need to complete a wellness assessment (which can be done online), to tap into the Benefit Booster. Claims will pay from this benefit first – helping to preserve savings and day-to-day benefits for members. Managed Care At the launch, Dr Morgan Mkhatshwa,Head of Operations said, ‘Lifestyle diseases have reached epidemic proportions in South Africa. 80% of these Non-Communicable Diseases (NCDs) are caused by lifestyle risk factors like smoking and obesity.  Managed Care is designed to help members with chronic conditions by using the best clinical and treatment protocols. This is achieved by analytics and continuous research, alignment to the latest technology, market trends and member needs and leveraging this data for enhanced treatment.   Oncology Cancer prevalence is increasing alarmingly. As a result, coordination of care is critical for oncology. Bonitas is introducing a new Oncology Management Programme that utilises a partnership between Medscheme Managed Healthcare and the South African Oncology Consortium (SAOC), to improve the coordination of care of oncology patients. Back and Neck Programme ‘Our back and neck programme has seen a 93% success rate. In 2022, we introduce the eDBC app.  This technology-driven channel offers digital coaching solutions and home-based care to help improve pain and mobility. It includes a self-assessment, baseline progress checks and outcomes’ evaluation.’ The GP is key ‘The Scheme believes that the GP is at the heart of the Managed Care model. Care coordination is essential in ensuring that members get the right level of care and support in managing their conditions. Our GP network has a broad national footprint and 98% of members are within a 10km radius of a network GP.’ Virtual Care BonStart, the inaugural Edge plan introduced in 2020, proved very successful – using virtual care as its base. For this reason, the Scheme is introducing an additional Edge plan, BonStart Plus for 2022, aimed at attracting a new profile of member through this diversified distribution channel and attractive pricing. Virtual care has proven a sound and reliable solution, locally and internationally, for improving access to quality healthcare and is now offered across all 15 Bonitas plans.   Digital Covid-19 spurred progression of digital enhancements with innovations such as a mobile app and WhatsApp channel being swiftly created. The Member Zone is being enhanced allowing members to manage their medical aid more effectively.  Amalgamations Callakoppen says, ‘Bonitas’ track record for amalgamations is excellent and we are currently awaiting approval from the Competition Commission to our proposed amalgamation with the Nedgroup Medical Aid Scheme. The amalgamation will fortify the size of Bonitas as well as decrease the average age and pensioner ratio while bolstering the reserves.’  Travel benefits  ‘We wanted to ensure that our members are covered should they need to travel and noted that testing and enforced quarantine could be expensive. The Scheme is therefore offering a Covid-19 PCR test pre-

September 22, 2021
Bonitas – innovation, life stages and quality care

Covid-19 Information for Moms-to-Be

Pregnant women do not appear to be more severely unwell if they develop Coronavirus than the general population. As this is a new virus, how it may affect you is not yet clear. It is expected the large majority of pregnant women will experience only mild or moderate cold/flu like symptoms.

September 16, 2021
Bonitas – innovation, life stages and quality care

Urban living’s impact on our wellness

South Africa is urbanising rapidly: 63% of South Africans are already living in urban areas.  Stats indicate this will rise to 71% by 2030 and by 2050, eight in 10 people will be living in urban areas. While it is unavoidable that people migrate to cities for work, it does have a negative effect on people’s health. The most significant effect is the increase in non-communicable or lifestyle diseases.  Dr Morgan Mkhatshwa,Head of Operations at Bonitas Medical Fund, says that the main problems associated with changes in lifestyle and behaviour, due to urbanisation, are: Increased alcohol and tobacco use Lack of exercise.  Cities are often over-populated, there are too few public spaces for physical activity and many residents have to use public or private transport because of long commutes to work, schools and amenities 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 Socio-economic factors There is an increasing recognition of the importance of social, economic and physical environments as determinants of health and well-being. Unfortunately, the poorest people living in under-serviced inner city areas or informal settlements are the most exposed to unhealthy urban environments. With urbanisation, the double burden of non-communicable diseases (NCDs) will increase if no effective health systems and policies are put in place to prevent, detect and treat communicable and non-communicable diseases. ‘Our analysis of lifestyle diseases indicate that hypertension is the most prevalent non-communicable disease, followed by high cholesterol and diabetes Type 2. Obesity, high cholesterol, diabetes Type 2 and hypertension are all symptoms of metabolic syndrome, caused by poor nutrition and a sedentary lifestyle. ‘The science around nutrition has long been problematic. Published results have varying conclusions but concur that highly processed and food with high sugar and “bad fat” content should be avoided. ‘Also, in the top seven conditions are susceptibility to blood clotting, asthma, underactive thyroid and depression,’ says Dr Mkhatshwa.  Asthma is a respiratory condition most often caused by pollution or other irritants in the environment and mental health conditions can also be a consequence of urban living. Oncology is also becoming more and more prevalent. The number of Bonitas members with cancer has more than doubled since 2016. Air pollution Motor vehicle, industry and domestic fuel use increases air pollution which is responsible for a range of lung and respiratory diseases, heart conditions and cancers. Chronic Obstructive Pulmonary Disease (COPD) and asthma are two of the most prevalent respiratory diseases.  ‘We have the expertise to respond to these risks and lifestyle diseases by providing comprehensive, integrated care, every step of the way,’ explains Dr Mkhatshwa. ‘And, through our Managed Care programme, we help equip our members to take responsibility for their health by providing information and education, encouraging wellness, paying for preventative care and providing cover for medical costs incurred.  However, more needs to be done and we advocate collaboration with public health authorities to educate and encourage South Africans to look after their health.’ Covid-19 and NCDs It is common knowledge that Covid-19 and non-communicable diseases such as hypertension and diabetes interact to create a perfect storm. The pandemic has made people more aware of having to take responsibility for their health and preventing or managing chronic disease optimally. ‘Co-morbidities have an impact on those who contract Covid-19 and there is possibly a synergistic issue with the coronavirus and these co-morbidities that exacerbates the prognosis and burden of disease.’  Managed Care ‘Achieving good patient health outcomes is the fundamental purpose of healthcare,’ says Dr Mkhatshwa. ‘Measuring, reporting and comparing outcomes is perhaps the most important step towards unlocking rapid outcome improvement and making better choices.   ‘Managed Care is a critical component and improves quality of care and we know that proactive intervention and working with members to prevent or control lifestyle diseases is the only way forward. Because when ‘I’ becomes ‘we,’ illness can become wellness.’ The GP is pivotal  We believe there needs to be coordination of care and that members should be encouraged to nominate a General Practitioner as the first port of call for all health care needs, who can refer to a specialist or auxiliary provider as the need arises. This eliminates inefficiencies caused by ‘doctor hopping.’ ‘To tackle the rising burden of disease, we need medical schemes to work together with public health authorities, particularly in the context of the challenges of urbanisation, lifestyle diseases and the Covid-19 pandemic.’

September 13, 2021
Bonitas – innovation, life stages and quality care

Performing in a pandemic: Bonitas announces healthy annual results

Bonitas Medical Fund reported its financial results for 2020, with significantly bolstered reserves of R6.1 billion. Luke Woodhouse, Chief Financial Officer of Bonitas says, ‘The Fund, which has 40 years’ experience in the medical aid industry, had 333 141 principal members and total beneficiaries of 710 157 as of 31 December 2020. This accounts for 14% of the open scheme market, representing 8.3% of total market share.’ Bonitas ended 2020 with an unprecedented surplus of R1.7 billion (2019: R186.1 million). The surplus is the largest ever reported by the Fund and is largely attributable to the suppressed utilisation of non-COVID related claims expenditure. ‘The surplus was also positively impacted by the effective implementation of our strategic pillars, proactive risk management and prudent Board decisions in a unique, but volatile year,’ says Woodhouse.  ’Bonitas’s medium-term objective is to sustain solvency levels above the statutory minimum of 25% and to make meaningful, strategic decisions about current reserves in the interests of our members. This while facing significant uncertainty, especially in terms of the cost and prolonged impact of COVID-19, non-COVID-19 utilisation and roll-out of vaccines.’ 2020 performance at a glance:  R3 billion gross healthcare result (2019: R1.3 billion) Reserves reaching R6.1 billion (2019: R4.3 billion) A net surplus of R1.7 billion (2019: R186.1 million) Solvency ratio of 32.7% (2019: 24.9%) R51.7 gross recoveries from Fraud, Waste and Abuse (2019: R41.2 million)   Strategic purchasing yielded hospital negotiation savings of R346 million (2019: R370.4 million).  This is lower than the previous year, in absolute terms, due to lower outflows as a result of COVID-19, including cancellation of elective procedures and a reduction in trauma and major medical related costs An investment income of R316.6 million (2019: R420.1 million) that exceeded CPI  Net claims decreased by 4.7% to R14.3 billion (2019: increased by 8.9% to R15.0 billion) Healthcare cost savings initiatives realised savings of R221m – the most significant of these were achieved through the Scriptpharm chronic medicine capitation model  83.0 claims loss ratio (%) (2019: 92.3)  The Investment Committee was particularly active given the volatility in equity markets and the market crash that occurred in March 2020. The active management and continued strategic asset allocation approach contributed to a turnaround in investment returns, growing the investment portfolio (excluding cash and cash equivalents) from R5.01 billion in December 2019 to R7.14 billion at the end of December 2020 – delivering an overall return of 4.16%. Although COVID-19 induced severe capacity constraints in the healthcare system, the hiatus in all other areas of healthcare decelerated a long-term trend towards overuse and medical cost inflation. This occurred against an economic backdrop of market volatility, record low interest rates, rising unemployment and declining incomes. The significant surplus capacity was systemic within the healthcare industry.  Investments and economic growth In addition to investment volatility, South Africa’s sovereign credit rating was downgraded to sub-investment grade status with a negative outlook by the Moody’s and Fitch ratings agencies. According to the IMF, South Africa’s real GDP contracted by 8% in 2020, but is expected to show 3% growth in 2021, before slowing again. Claims’ expenditure While some categories such as in-hospital admissions experienced a major decline, with a high number of elective surgeries cancelled, there was a marked increase in medicine claims and costs. Under servicing could, however, lead to higher downstream healthcare costs over the long term. The combination of these factors led to lower claims in an environment where Bonitas actively continued to manage costs, promote Managed Care and supervise investment performance. As opposed to other years the key cost drivers were COVID-19 related, including: Hospital admissions, investment in PPE, pathology test costs, home-based care, healthcare support to members in the workplace, medication and deferred elective surgeries.  Hospital negotiations This year we participated in the first collective negotiation process on hospital tariffs with five other medical schemes administered by Medscheme. This followed the finding by the HMI that collective negotiations would not contravene the Competition Act. The common tariff resulted in a 3.1% saving in 2021 terms and these savings could exceed R200 million in 2021. In addition, hospital costs and medical specialist costs reduced by 5.4% (2019: increased by 8.9%) and 5.3% (2019: increased by 10.0%) respectively on a per-member-per-month basis. Total claims per-member-per-month declined by 8.7% (2019: increased by 8.1%). Strategic purchasing  Cumulative savings since the start of the strategic partnership arrangement with hospital groups in 2017 was R1.247 billion.   Growth and retention To retain members under significant financial stress due to COVID-19, members received assistance in line with CMS regulations This had a negligible impact on performance but assisted in retention of members during the worst of the pandemic. COVID-19 also resulted in a marked increase in queries about joining a medical fund as people realised the need for quality healthcare. We experienced a cumulative net decline in membership of 5 610 members (1.7%) in 2020, which compares well against a significant contraction in GDP and increased unemployment. Despite the challenges experienced in 2020, Bonitas acquired 37 814 new members (2019: 50 680). Bonitas also kept increases as low as possible without jeopardising the sustainability of the Fund. There was a competitive weighted average contribution increase of 4.6% – 1.61% higher than CPI whereas, under normal circumstances, contribution increases are set at a minimum of CPI +3,5%. Day hospitals We identified day hospital use as a viable option to improve efficiency and reduce costs. There is minimal disruption to members, speedier recovery times, less risk of infection.   Home-based care  During COVID-19, home-based care received renewed interest and focus. Not only is it a cost saver but studies have shown that patients recover faster in their comfort of their own homes. Efficiency Discounted Options (EDOs)  The four EDOS introduced have been a success – the EDOs cover over 74 000 lives and the principal members who join are around 10 years younger than the average Bonitas member. Members on these plans use network healthcare providers and pay around 15% less for the same benefits.  Virtual

August 30, 2021
Bonitas – innovation, life stages and quality care

Caring for Baby

The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion. Circumcision care Newborn circumcision is a surgery that removes the loose skin (foreskin) that covers the end of a baby boy’s penis. It may be done for various reasons and usually heals with 7-10 days. Follow the care instructions you were given by your baby’s doctor. Often times they will recommend that you use a small amount of petroleum jelly on the site at diaper changes to prevent irritation. Contact your baby’s doctor if you see blood or pus around the circumcision or if you smell an odour coming from the site. Myths about newborns The following are common myths about newborns: Myth: Don’t touch their “soft spots” – Truth: Known as the fontanels, these areas are a thick protective membrane, not your baby’s brain, so if you happen to touch them gently nothing bad will happen; as with all of your baby, handle that area with gentle loving care. Myth: Baby girls don’t have periods – Truth: Baby girls may have a “mini period” within the first few weeks of life which is the result of the stimulation of their uterus by Mom’s high estrogen levels. If you ever have questions about what’s happening with your baby, contact your doctor. Myth: Babies don’t get acne – Truth: Some newborns will develop acne due to circulating hormones from their mother between 2 weeks and 2 months of age; you don’t need acne creams, just cleanse the area gently. Myth: Babies have flat chests – Truth: Some babies may temporarily have swollen breasts due to their mothers circulating hormones; this can happen to boys and girls. Myth: Sneezing must mean my baby has a cold – Truth: Newborns have tiny noses and often have some congestion, so they may sneeze a lot at first; if they have thick, coloured mucus and are sneezing a lot then they may be developing a cold. Never hesitate to contact your doctor if you are worried about what’s going on with your baby. No question is ever “dumb” if you are worried. Bathing your newborn Your baby doesn’t need a full bath every day, only 3-4 times a week. When giving them a full bath make sure the water is warm, but not hot, by testing the temperature with your elbow – if it’s too hot for your elbow, it’s too hot for your baby. Use mild bath soap made specifically for babies – harsh soaps may dry and irritate their skin. Always keep one hand on the baby while they are in the bathwater. There are some parts of your baby that will need to be washed with mild soap every day, especially their face, chin, neck and bottom. Do not use soap on their belly button (navel) or on a circumcision until it’s healed. Make sure the room you are in to bathe your baby is warm and free of drafts. Every baby is different so don’t hesitate to talk with your baby’s doctor if you have any questions about caring for your newborn. Healthy skin for newborns You don’t need to use lotion or powder on your baby unless it’s been recommended by their doctor. Don’t use fabric softener or bleach on their clothes as these can irritate their skin. Use mild detergent to wash their clothes, making sure to wash new clothing before you put it on the baby. Be careful not to overdress your baby – if you are comfortable in a t-shirt and shorts, your baby will be fine in a t-shirt or short sleeved onesie and a diaper. Diaper care for your newborn Periodically check your baby’s diaper to see if it’s wet or soiled. Change their diaper whenever one becomes wet or soiled. When changing your baby’s diaper, wash their bottom with mild soap and warm water or use disposable baby wipes. Be sure to wash your hands each time you finish changing a diaper. Additional tips for care of newborn For mouth care, wipe you baby’s gums daily with a clean damp washcloth or an infant toothbrush. To prevent scratches, keep your baby’s finger and toenails cut short. Remember that newborns sleep a lot – usually between 16-18 hours a day. Make sure to schedule your baby’s first check-up as recommended by their doctor – it’s usually recommended between 2-4 weeks of age. Umbilical cord care Do not place the baby in bath water until after the umbilical cord stump has fallen off. Keep the umbilical cord stump clean and dry – if it becomes soiled you can clean it with a cotton ball, mild soap and water. Umbilical cord stumps usually fall off about 2-4 weeks after birth – contact your baby’s doctor if this doesn’t happen. If the umbilical cord stump turns red around the base, bleeds, develops coloured drainage or a bad odour contact your baby’s doctor right away since it could be a sign of an infection. Contact your baby’s doctor if you have any questions or concerns about your baby’s umbilical cord stump. Teething pain relief The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion. To help soothe the pain from teething give your baby a teething ring, a wet washcloth cooled down in the refrigerator, or feed him/her cold foods such as applesauce or yogurt. You can also talk to your doctor about giving your baby acetaminophen (Tylenol) to ease the pain.

August 20, 2021
Bonitas – innovation, life stages and quality care

Digital Covid Hub drives education and vaccinations

The 3rd wave of Covid-19, which is predominantly the Delta variant, is having a major impact on our healthcare system with reports of hospital admissions being significantly higher than during waves 1 and 2. ‘We can attest to this by the ongoing monitoring and analysis provided by our actuarial teams’, says Lee Callakoppen, Principal Officer of Bonitas Medical Fund.  ‘In 2020 we had a total of 8 111 members hospitalised due to Covid-19 as opposed to 7 815 over the past six months.’ Covid Hub – education for everyone ‘At the outset of the pandemic, 18 months ago, we created an informative and educational Covid-19 hub to create a reliable source of information and to educate and empower our members,’ explains Callakoppen. ‘The information includes helping identify symptoms, providing guidelines on how and where to be tested and receive treatment.’  Recently, the Fund enhanced and bolstered this centralised, digital Covid-19 information hub and made it accessible to all South Africans – www.bonitas.co.za/covid. ‘As new scientific data became available, we continued to update the hub, highlighting key topics such as safety protocols, the different types of Covid-19 tests, dispelling myths around the vaccine and explaining the difference between Covid-19, the common cold and flu. One of the key elements is the comprehensive guide to recovering from Covid-19 which includes tips for caregivers, the do’s and don’ts of Covid-19 recovery, as well as post-Covid care tips.’ ‘Now, given the increased vaccination drive and it being opened to a wider group, we have further enhanced the site to assist our members with registration and help speed up the process at Bonitas vaccination sites.’ Private vaccination sites for all To support the Department of Health’s ongoing efforts to vaccinate as many South Africans as possible, Bonitas has vaccinated over 100 000 South Africans at its private vaccination sites across the country. A quarter of whom (25 245) were Bonitas members. At present, the 50+ age groups are being vaccinated, with registration and vaccinations for 35+ now open. The 10 sites adhere to all the required safety regulations and are staffed by qualified nurses, additional sites are due to come on-line in the new few weeks.   ‘As of 13 July 2021, there were 2 031 Bonitas members in hospital, compared to 1 893 the week before and 1 598 at the end of June,’ says Callakoppen. ‘We have conducted a total of 338 981 PCR tests, 150 430 of these were between January and July 12th – with 28 097 members testing positive. This is a 44% increase over 6 months. ‘However, studies have shown that once people are vaccinated, they’re far less likely to fall seriously ill and that the vaccine provides protection against hospitalisation for the Delta variant, which is why the vaccine roll out is critical.’ This aligns with the recent statement from Dr Marian van Kerkhove of the World Health Organisation (WHO): ‘The Covid-19 situation globally is dangerous with high levels of transmission driven by four major factors. The first are these variants of concern, including the Delta variant. The second factor is that we have increased social mixing and social mobility, which increases the number of contacts that individuals have. The third factor is the relaxation or the inappropriate use of public health and social measures. Proven public health and social measures that we know prevent infections, reduce the spread of somebody who is infected with the virus to others and save lives. And the fourth factor is the uneven and inequitable distribution of vaccines.’ Herd immunity Vaccinating as many people as soon as possible remains a priority if we are to minimise the impact of Covid-19.  To achieve herdimmunity, the South Africa’s Department of Health is aiming to vaccinate 67% of the country’s population – this equates to around 41 million people.  ‘It’s heartening to learn that vaccine acceptance is growing in South Africa, with the latest Covid-19 study revealing that 76% of the population are willing to be vaccinated.  The daily average number of doses administered over the past week – counting only weekdays between Monday and Friday – amounts to 150 000 – reaching a total of just over 5 million with 1,67 million South Africans having received both doses.  This means 2.9% of the population is fully vaccinated.  Plans are in place to ramp this up over the next few weeks, which will include sites being open over weekends and to widen the groups being vaccinated. Educate and vaccinate In collaboration with service providers and employer groups, the Fund’s private vaccination sites also promote key Covid-19 messages, with take home educational leaflets that can be shared. ‘In addition, we have begun the process of opening vaccination facilities at major scheme employer sites, such as Eskom,’ says Callakoppen. ‘We are continually engaging with corporates to improve the support we provide.’ Identified high-risk beneficiaries are also being supported through various initiatives, including disease management interventions, home-based care and medicine supplies where required.  QR Code replaces forms  ‘Complaints about queues and waiting times at some sites have been taken into consideration,’ says Callakoppen. ‘We have streamlined the process for members by providing access to a QR code, upon registration on the EVDS and our portal. This means that they are scanned upon arrival, eliminating any delay by having to fill in forms – allowing for a smooth and efficient process.’ Registration should still be done via the Government website on https://vaccine.enroll.health.gov.za and everyone must remember to take along their unique token, ID document or passport to the vaccinations site. If you’re on a medical aid, make sure you have your medical aid card with you.  ‘We need to remain on high alert about the pandemic,’ warns Callakoppen.  ‘It may be day 477 but we cannot afford to be complacent. We must all play our part to stay safe, which means following the protocols and getting vaccinated.   ‘The vaccination process is a key focus area for us, along with education. We will continue to use our Hub (available at www.bonitas.co.za/covid) as a central resource for factual information. A

August 3, 2021
Bonitas – innovation, life stages and quality care

Generics and biosimilars – champion cost savers in the healthcare industry

It is common knowledge that healthcare costs rise exponentially and medical schemes have to find ways to reduce costs both for the medical scheme and its members. Kathy Malherbe spoke to Dr Morgan Mkhatshwa, Head of Operations at Bonitas Medical Fund, about generics and biosimilars and how they contribute towards reducing healthcare costs. One of the cost drivers is medication which is why The Pharmacy Act of 1997 and the Medicines Control Amendment Act, among other things, have made it mandatory for dispensers of medicine, be they doctors or pharmacists, to offer a patient a generic substitute if one is available. However, generics are not the only cost savers.  The patent expiry on many biological medicines is opening the door to more affordable, life-saving ‘biosimilars’ to be produced – another ‘champion’ in the pharmaceutical industry.  Increased consolidation in the healthcare industry is also having a positive impact on medicine prices and availability. Medical aids are trying to create more competition, even among medicines that are still under patent. They are also tightening up their formularies, in part to encourage pharmaceutical manufacturers to provide better pricing.   What is a generic drug?  A generic is a pharmaceutical drug that contains the same chemical substance as a drug that was originally protected by chemical patents. It is an exact copy of brand-name drugs that has the same dosage, intended use, effects, risks, safety and strength as the original. In other words, their pharmacological effects are identical to those of their brand-name counterparts. But at a much more affordable price… Generic medicines cost, on average, between 30 and 80% less than the original.  What guarantee is there that generics are true replicas?  In South Africa, the Medicines Control Council (MCC) carries the responsibility of making sure that generic drugs are safe and effective. Generic drug manufacturers have to prove their medicine is bioequivalent to the original brand before a product is approved into the local market.   What is a biosimilar? Biological drugs are large, complex proteins made from living cells through highly complex manufacturing processes. Biosimilars are a close equivalent but not exact copies of biologicals. and are manufactured after the patent for the biological/reference drug ends. To be called a biosimilar drug, it must be shown to be safe, work as well as, and work in the same way as its reference drug – the biological. It must also be used in the same way, at the same dose, and for the same condition as the reference drug. The cost of manufacturing biological medicines is more expensive than conventional chemically produced medicines and, because biosimilars are close copies, they remain expensive but are still more cost effective that the original.  What are they used to treat? The most important biological medicines are used to treat conditions such as rheumatoid arthritis, Crohn’s disease, multiple sclerosis, diabetes and cancers. How are they different from generics? The reason biological copies are called biosimilars is that, unlike generic medicines, the active ingredients are not exactly the same as the original but ‘similar.’ It is impossible to make identical copies when ‘translating’ biological molecules from living cells in the laboratory. Very importantly to note though, is that even though biosimilars are not a direct copy, the therapeutic effect is the same as the original biological product. Why are generics and biosimilars less expensive? Generics Pharmaceutical companies are researching and testing new active ingredients and medicines all the time. The patent is valid for about 20 years which means that only the approved company may research, create a new formulation (the ‘recipe’ and process for creating the actual medicine) and register the medicine. This takes years and carries a huge financial burden. After about 8 to 10 years on the market the patent usually expires and other drug companies can make an exact copy of the drug without the initial clinical research costs. Biosimilars While these medicines have revolutionised treatments for many diseases, the research and development expenses, including the costs of highly skilled scientists, clinical trials and the specialised equipment needed, are the main cost drivers. Companies are required to fund these costs, often in excess of 10 years, before registration for use by patients.  Biosimilars save costs because: The molecule and effects have already been discovered and identified by the originator The number of patients required in the clinical trials is reduced The original biological medicine would have been ‘manufactured’ at least 20 years ago. New manufacturing methods are more efficient. The cost-efficiencies, which generic and biosimilar medicines provide, are assuming greater importance for state and private health funders as populations age and the prevalence of cancers and other non-communicable diseases increase.  SA’s already stretched healthcare budget is coming under increasing pressure to fund the high cost of pharmaceuticals, especially biological medicines. While generics and biosimilars may not be a panacea for high healthcare costs, they will go a long way towards offering a cost-effective, quality treatment for a large range of diseases. In addition, these breakthrough treatments can halt progression and sometimes even prevent recurrence by acting on proteins that affect the genome/immune system.

July 5, 2021
Bonitas – innovation, life stages and quality care

Toddler Milestones

The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion. Growing children Children grow and learn at their own pace. It is normal for your child to be ahead in one area, but behind in another.  Learning what is normal for each age group can help you feel comfortable with where your child is at and spot any problems early on. Milestones: age 2 Milestones for age 2 include: Walking by themselves; this usually takes place between 9-17 months with the average being 14 months Running: about 6 months after learning to walk Climbing stairs and onto furniture Kicking a ball Ability to scribble with crayons, pencils or markers Imaginative or make-believe play Communication includes using real words by 15-18 months and simple phrases by 18-24 months Milestones: age 3 Milestones for age 3 include: Improved balance: can stand on one foot for a short time, can petal a tricycle and can walk upstairs without holding the railing All baby teeth have come through Potty trained during the day 20/30 vision Communication includes increased vocabulary (hundreds of words), uses short sentences, uses plurals and pronouns and asks many questions Can dress self with exception of laces, buttons, etc. Knows their name, age and gender Learns to share Milestones: age 4 Milestones for age 4 include: Hops on one foot well Throws a ball overhand well Uses scissors to cut out a picture Communication includes increased vocabulary (thousands of words), uses longer sentences, uses past tense and asks even more questions than ever Learns simple songs Starting to understand time better Milestones: age 5 Milestones for age 5 include: 20/20 vision Increased coordination: skipping, jumping and hopping well Learning to use writing utensils well Communications includes increased vocabulary (over 2000 words), uses sentences with 5 or more words and uses all parts of speech Knows the primary colours Learning to understand math Learning to behave with more responsibility and less aggression

June 14, 2021
Bonitas – innovation, life stages and quality care

Infant Milestones: the first year

The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion. Milestones: 1-3 months Milestones for months 1 to 3 include: Ability to raise head and chest when laying on stomach Stretches arms out and kicks when laying on back Smiles purposefully Enjoys playing with other people Can follow a moving object with eyes Ability to open and shut hands and bring hands to mouth Ability to grasp and shake a toy Communication includes facial expressions and body movement, coo’s and babbles Begins to imitate some sounds and expressions Begins to recognize toys and people from a distance Hand-eye coordination improving Milestones: 4-7 months Milestones for months 4 to 7 include: Uses hands and mouth to explore Can find a partially hidden object Attempts to get objects that are out of their reach Can roll from back to tummy and tummy to back Can sit by self for a short time, with or without hands and sit in a highchair Ability to transfer toys between hands, point and reach for objects Communication includes using more variety of sounds and pitches; uses sound to reflect moods, babbles to get attention and can imitate sounds better Play becomes more intentional Milestones: 8-12 months Milestones for months 8 to 12 include: Can move to a sitting position and crawling position on his/her own Crawling Sitting independently Pull up, stand and walk while holding onto furniture; may even take a few steps independently Grasp objects with thumb and first finger; can finger feed themselves Place toys into containers and take them out; find toys that are hidden Communication includes saying mama and dada, oh-oh, shaking head yes or no and imitating other sounds; may even say their first word Uncomfortable around strangers and cries when mom or dad leaves

June 7, 2021
Bonitas – innovation, life stages and quality care

Boosting your immune system

The global pandemic has highlighted more than ever the need to stay healthy and keep our immune systems as strong as possible.  It is well documented that people with  co-morbidities and poorly functioning immune systems are at the highest risk of getting really ill from Covid-19.  Although you cannot suddenly reverse a co-morbidity or instantly boost your immune system, now is a good time to make your health and natural defences a priority.  Dr Morgan Mkhatshwa, Head of Operations at Bonitas Medical Fund offers some input as to how to boost our immune system and keep it that way.  What is the immune system? The immune system is a complex network of cells and proteins that defend the body against infection.  It also keeps a record of every germ (microbe) it has ever defeated, so it can recognise and destroy the microbe quickly if it enters the body again. Dr Mkhatshwa stresses the fact that Covid-19 is a novel (new) pathogen which means our bodies don’t have any existing antibodies to mount a defence. For that reason, it remains imperative to continue wearing masks and practising social distancing, hand hygiene and cough etiquette. Can over-the-counter vitamins and supplements help?   There is no magic pill that will instantly boost your immune system. However, together with a healthy lifestyle habits, various supplements can boost your immune system and give you a fighting chance.  What are considered useful vitamins and supplements to take? The recommendation for general health is a combination of 5 essential vitamins and minerals to keep your body healthy. These include: Vitamin C:  Supplementing with Vitamin C has been shown to reduce the duration and severity of upper respiratory tract infections, including the common cold. This vitamin can also be found in oranges, grapefruit, broccoli, strawberries, red bell peppers and tomato juice. Vitamin D: Also fights off infections and maintains strong bones. Vitamin D has been highly researched in connection with Covid-19 because of its effect on the immune system. – it is found in salmon, mushrooms, milk, cereals and breads. Studies have shown that Vitamin D can expedite healing and stall inflammation in the respiratory system but there has not been robust clinical evidence to prove its use against Covid-19. Vitamin A:Helps regulate the immune system and protects against infections by keeping your tissues and skin healthy – it can be found in sweet potatoes, carrots, apricots and spinach. Vitamin E: Is an essential antioxidant that helps fight cell damage. Nuts and peanut butter are filled with Vitamin E. Zinc: Works as an antioxidant and boost the metabolism along with healing wounds.  Meat, shellfish, beans/legumes and nuts/seeds are high zinc foods. Zinc is needed for immune cell development and communication and plays an important role in inflammatory response. A deficiency in this nutrient significantly affects your immune system’s ability to function properly, resulting in an increased risk of infection and disease. It has also been highly researched in the fight against Covid-19 but sadly has not shown any proven clinical results. Taking a deep breath – the science behind breathing and the immune function Your mental state influences your physical health. Our immune and lymphatic systems are chemical based so we are essentially a collection of chemicals, from our brains to our bones.  The air we breathe converts into chemicals that we need to fuel our cells. The way we breathe matters and even impacts our body chemistry. The physiological responses to deep, controlled, mindful breathing is so profound that if we could bottle them and sell them as drugs, they’d be worth a fortune.  Learn to exhale, activate your diaphragm, breathe deeply and work on fixing your posture. Simply thinking about better breathing will trigger positive immune responses. Breathing slowly and deeply is one of the most effective things you can do right now for your wellbeing. The immune function and auto-immune disease are complex topics. The state of our health is not black and white, nor can it be affected by one-stop solutions. A holistic approach to health will always win against quick fixes. Once we understand that, improvements in these essential body systems can happen naturally.  Will the flu vaccine help your immunity?  Flu vaccines have been shown to reduce the risk of influenza illness, hospitalisation and death. Not only will flu vaccinations reduce the risk of getting flu but are an important conservation measure for scarce health care resources. This remains a concern with the ongoing the Covid-19 pandemic.  A protective antibody response takes about 2 weeks to develop so should be taken early.  The third wave of Covid-19 in South Africa, as predicted by The National Institute for Communicable Diseases (NICD), has begun and Dr Mkhatshwa recommends doing everything you can to boost your immune system, according to your personal preference.   In terms of Covid-19, it’s especially important to understand that no supplement, diet or other lifestyle modification, other than social distancing and proper hygiene practices can protect you. 

May 28, 2021
Bonitas – innovation, life stages and quality care

Free Flu Vaccines

Annually, seasonal influenza (flu) kills around 11 500 people in South Africa. Which is why Bonitas Medical Fund offers flu vaccines annually at no cost – to every member and beneficiary. The Fund has announced that the cost of administering the flu vaccine – as well as other vaccines covered from the risk benefit – will also be covered or subsidised for its members. Flu vaccines have been shown to reduce the risk of contracting flu, becoming seriously ill if you do, being hospitalised and even death. Flu vaccinations are also an important conservation measure for scarce health care resources, which remain a concern during the ongoing the Covid-19 pandemic. According to Principal Officer of Bonitas, Lee Callakoppen, the World Health Organization (WHO) has also recommended that high risk groups consider having the flu vaccination in 2021, particularly because of Covid-19. ‘As part of our preventative care benefit, we offer free flu vaccinations annually to our members to help maintain their health and immunity.  ‘Due to the unique circumstances created by the pandemic and our members being financially constrained, we have negotiated with our network of over 60 pharmacy groups – which include Dischem, Clicks and PnP – to cover cost of the flu administration fee, capped at R50. However, should a provider charge more than R50, the shortfall will be for the member’s account.’ He says the Scheme is financially stable and sound and has set aside funds to cover the flu vaccine – estimating around 40 000 doses will be utilised during the 2021 season – along with the administration costs.  Although the flu vaccination is free to all members, the Scheme (guided by WHO and the Department of Health) highly recommends that the following groups consider being vaccinated: Healthcare workers Individuals over the age of 65 years  People with comorbidities like heart disease, diabetes or lung disease  Pregnant women  People living with HIV and AIDS  ‘We believe the best and first form of defence against flu is the vaccine,’ says Callakoppen. ‘And we suggest people get vaccinated soon, ahead of the flu season – which traditionally runs from May to August because the protective antibodies take about two weeks to develop. However, we know that protocols in place for Covid-19 such as social distancing, wearing a mask, handwashing and sanitisation will also go a long way in protecting against us against getting flu.’ In addition to the free flu vaccination and as part of the preventative care benefit, Bonitas also covers the costs of a pneumococcal vaccine for beneficiaries over the age of 65 years once every 5 years and childhood immunisation, this includes the vaccine admin fee. 

May 20, 2021
Bonitas – innovation, life stages and quality care

Gestational Diabetes: Reasons, risks and recovery

Kathy Malherbe speaks to the clinical team at Bonitas Medical Fund to get some insights on Gestational Diabetes (GDM) and tells the story of mother-of-two, Theresa’s (36) experience with Gestational Diabetes. Diabetes is a condition whereby your body is unable, in varying degrees, to produce or respond to the hormone insulin. This causes abnormal metabolism of carbohydrates and elevated levels of glucose in the blood. Diabetes is commonly divided into four types: Type 1, Type 2 (often lifestyle related,) Gestational Diabetes and Diabetes Mellitus. Normally when you eat, your blood sugar rises. The pancreas, a gland deep in your abdomen, releases a hormone called insulin. It helps move sugar from your blood into your cells for energy and storage. In a non-diabetic person, the blood sugar will go back down to normal after eating.   What is Gestational Diabetes? Gestation comes from theLatin gestare, which means ‘to bear’ or ‘give birth to’. Medically speaking it is the period between conception and birth. There are two types of Gestational Diabetes. Women with class A1 can manage it through diet and exercise. Those who have class A2 need to take insulin or other medications. Gestational Diabetes usually goes away after you give birth. But it can affect your baby’s health, and it raises your risk of getting Type 2 diabetes later in life Unlike Type 1 diabetes, Gestational Diabetes is not caused by a lack of insulin but by other hormones produced during pregnancy that can make insulin less effective, a condition referred to as insulin resistance. Gestational Diabetic symptoms disappear following delivery. Why does it develop? During pregnancy, your placenta makes hormones that cause glucose to build up in your blood   and produces a hormone called the Human Placental Lactogen (HPL). HPL breaks down fats from the mother to fuel the growth of the baby. Usually, your pancreas can send out enough insulin to handle it. But if your body can’t make enough insulin or stops using insulin as it should, your blood sugar levels rise and you get Gestational Diabetes. It can lead to insulin resistance and carbohydrate intolerance in the mother.  Who is at risk? About 10% of pregnancies result in Gestational Diabetes. The causes are not known but the risk factors include:  Age-older women  High blood pressure, high cholesterol, heart disease Obesity Not exercising   Immediate family history of diabetes History of Gestational Diabetes in a previous pregnancy Have had a miscarriage or a stillborn baby Polycystic Ovarian Syndrome It is important to note that there is no definitive way to prevent Gestational Diabetes. Even mothers who have had Gestational Diabetes in a previous pregnancy may not get it with a later pregnancy. Warning Signs of Gestational Diabetes Sugar in the urine Unusual thirst Frequent urination Fatigue Nausea Blurred vision Vaginal, bladder and skin infections. When and how is it detected? In most cases, Gestational Diabetes develops in the second or third trimester (from week 14 to the birth) and disappears after the baby is born. A screening or finger prick blood test can be done at a clinic or pharmacy to give you a snapshot of your blood sugar levels. However, a formal diagnosis requires a blood test and sometimes this will need to be repeated. Gestational Diabetes is detected by using an oral glucose tolerance test (OGTT) or a random blood glucose test.  The OGTT test is done by a nurse or doctor taking a blood sample from your vein to test the blood sugar levels.  Then you will drink a glass of water mixed with glucose. An hour later you will have another blood test. Your blood glucose level should rise after you finish the sugary drink, then go back to normal, as insulin moves glucose into your cells. If it takes too long to go back to normal you could have diabetes. What the test shows The blood glucose is measured in milligrams per deciliter (mg/dL). Two hours after you finish the glucose drink, this is what your results mean: Below 140 mg/d: Normal blood sugar  (7.8mmol) Between 140 and 199: impaired glucose tolerance or prediabetes (11mmol) 200 or higher: diabetes (11.1mmol) The random glucose blood test is carried out a couple of times to see if your glucose varies widely.  If initially you are not diagnosed with Gestational Diabetes, the test may be repeated at around 24-28 weeks.  What are the dangers? In many cases it can be controlled with a healthy diet and exercise but at least one in ten women will need their blood glucose levels controlled with medication. If your diabetes is not picked up during pregnancy it can cause risks at birth. The most prevalent is shoulder dystocia which is when the baby’s head gets stuck during the birth.  This can cause:  Fractures to the collarbone and arm Damage to the brachial plexus nerves. These nerves go from the spinal cord in the neck down the arm Lack of oxygen to the body (also called asphyxia). In the most severe cases, this can cause brain injury or even death  It can also lead to babies being large for their gestational age which can result in birth complications How can you help yourself? By adhering to an eating programme that is healthy for you and for your baby including:  Eat protein with every meal Include daily fruits and vegetables in your diet Limit or avoid processed foods Pay attention to portion sizes to avoid overeating Exercise regularly. Aim for at least 30 minutes of exercise 5 days a week. Just remember to speak to your doctor before starting any new exercises  Don’t skip meals. To regulate your blood sugar levels, aim to eat a healthy snack or meal every 3 hours or so. Eating nutrient-dense foods regularly can help keep you satiated and stabilise blood sugar levels. Take your prenatal vitamins, including any probiotics, if they’re recommended by your doctor. Being diagnosed with Gestational Diabetes can be extremely stressful and dangerous to both mother and baby.  It is imperative to have your blood glucose monitored during pregnancy. However, if you are tested regularly, stick to a healthy eating programme and exercise regularly,

May 6, 2021
Bonitas – innovation, life stages and quality care

Vaccines and the way forward

Bonitas Medical Fund, gives an update on Covid vaccines and how the Fund is positioned for the rollout to its members.  Various scenarios have been presented regarding the speed of propagation of the third wave – the worst assumption is that it will be twice as fast as the second wave. The best case scenario is that the virus is 50% more transmissible than the second wave. Regardless, the urgency for the roll out of the various phases of the vaccination programme is undeniable. Unfortunately private procurement of the vaccine is currently prohibited but as procurement is opened to other entities, we will take every step to ensure we have access to vaccines for our members.  We want to mitigate the risks of them contracting Covid-19 as well as getting seriously ill or dying, which is why we are working behind the scenes to ensure we are ready to roll out the vaccine to our eligible members. Medscheme (Bonitas’ administrator) is engaged and collaborating with the Department of Health (DoH), Business for SA, Board of Healthcare Funders (BHF) and various industry stakeholders in order to assist with the rollout from Phase 2. We are also in the process of requesting accreditation to set up private vaccination centres.  This will ease access for our ‘at risk’ members and provide a broader footprint, including remote areas of the country. Our over 10 000 members, who are healthcare workers, have already started the vaccination programme in Phase 1. There are around 72 000 members who are classified as ‘Essential/Congregate workers’ and 185 000 high risk members who are either over 60 or have comorbidities. We intend beginning the Phase 2 rollout as soon as the vaccine is secured.  The latest information on South Africa’s procurement of vaccines is that there are: 11 million doses of Johnson & Johnson (J&J) 20 million doses of Pfizer BioNTech A further 20 million doses of the J&J is being negotiated. This would be sufficient to cover the targeted 37 million adults in SA  Through collaboration with one of our partners, Afrocentric Health, we will be able to administer up to 150 000 vaccinations per day.   We are all familiar with the 3 Phase roll out plan as outlined by the DoH but there remains uncertainty about some definitions such as an essential worker – outlined in Phase Two: Essential workers, persons in congregate settings, persons over 60-years and persons over 18-years with comorbidities. The DoH announced from the onset that healthcare workers would be vaccinated in Phase 1.  Phase 2’s priority group would include essential workers, persons in congregated settings, persons 60 years and older and persons over 18 with comorbidities.  However, it has since been announced that, as a result of a shortage of the acquisition of vaccinations, these groups will be adapted in order of priority. As it stands on 8 April 2021 (subject to change), these groups include the following: Phase 2 Priority Group  Definition Essential workers Teachers, police officers, miners, workers in security, retail food, funeral, banking and essential municipal and home affairs, border control and port health services Persons in congregate settings  People in prisons, detention centres, shelters and care homes. In addition people working in the hospitality and tourism industry and education insititutions are also at risk Persons 60 years and older Persons older than 18 years with comorbidities Persons living with HIV, TB diabetics, chronic lung disease, cardiovascular disease, renal disease, obesity, etc What we have done is to ensure we know, upfront, who our high risk member population is and, once Phase 2 commences, we are able to ensure that all those who want to be vaccinated, will be. Together with our administrator, we have set up various processes to ensure we are able to achieve this goal to ensure peace of mind for our members.

April 14, 2021
Bonitas – innovation, life stages and quality care

Woman’s Health

Birth Control Side effects of birth control pills The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion. If you have just started taking birth control pills you may experience a headache, dizziness, breast tenderness, nausea, breakthrough bleeding, mood changes or other side effects. Be patient, these side effects often go away after a few months. If they don’t you may want to talk to your doctor about your options. Some positive effects of taking birth control are lighter (and sometimes fewer) periods, milder menstrual cramps, and improved acne. Consult your doctor if you have questions about what type of birth control is right for you. Women’s Nutrition Unsaturated fats: the good, the bad and the uglyThe following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion. There are two types of unsaturated fats, polyunsaturated fatty acids and monounsaturated fats. Polyunsaturated fats are found in most vegetable oils, flaxseeds and walnuts as well as in fatty fish such as salmon, and mackerel. Monounsaturated fats can be found in olives, avocados, hazelnuts, almonds, Brazil nuts, cashews, sesame seeds, pumpkin seeds, and olive, canola, and peanut oils. Both kinds of unsaturated fats may help lower your cholesterol and reduce your risk of heart disease. The bad fats, saturated and fatty acid fats should only be eaten on occasion. Lactose intolerant: the solution for getting your daily calcium intakeThe following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion. Lactose Intolerant? Scared of not getting enough calcium? Don’t worry; you can get calcium from eating foods that don’t contain lactose. These foods contain calcium, but are dairy free: Broccoli Leafy greens Canned salmon &sardines with edible bones Almonds Oranges Pinto Beans Tofu and soymilk Calcium-fortified breads Calcium fortified juices. Risks in Women Urinary tract infectionsThe following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion. If you are experiencing a burning sensation when you urinate, or feeling the need for frequent urination, leaking a little urine or cloudy, dark, smelly or bloody urine you may have a urinary tract infection. To avoid getting a urinary tract infection: Drink plenty of water to flush out bacteria Don’t hold your urine when you need to go Wipe from front to back after a bowel movement Try to urinate after having sex to wash away bacteria Do not use feminine hygiene sprays and douches, which may irritate the urethra and possibly begin a case of urinary tract infection Try vitamin C supplements which increase the acidity level of your urine which helps decrease bacteria Wear cotton panties or underwear Breast cancer prevention The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion. Although you should have a mammogram and clinical breast exam every 1 to 2 years if you are 40 and older, there are ways to examine your breasts in between visits. This helps you become familiar with your breasts and breast tissue, so you are more likely to notice any changes over time. Women may start doing self-breast exams any time after the age of 20. Here are the steps: Look at your breasts in the mirror for any abnormal changes in colour, size or shape. While lying down or taking a shower use the pads of your fingers to press firmly into your breast and move your fingers in a circle around the whole breast. Check for any abnormal lumps or changes. By limiting the amount of alcohol, you drink, maintaining a healthy weight, staying physically active, and limiting the bad, saturated fats in your diet you may lower your risk of breast cancer. Heart attack warning signs and prevention The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion. If you feel pressure or tightness in your chest, pain that goes from your chest into your jaw and/or left arm, or shortness of breath, you may be experiencing a heart attack. The most common symptom for both men and women is in fact tightness or pain in your chest; however, women are somewhat more likely to experience other common symptoms, specifically shortness of breath, nausea or vomiting, and back or jaw pain. Smoking, high cholesterol, high blood pressure, lack of exercise, stress and obesity are all risk factors for a heart attack. Quit smoking; exercise and maintain a healthy diet and weight to help decrease the risk. Also, talk to your doctor about whether aspirin could help reduce your personal risk of a heart attack. Aspirin may help keep your blood from forming clots that could eventually block arteries in the heart, causing a heart attack. Stroke warning signs The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion. A stroke is a blood clot or a break in an artery that interrupts blood flow to part of the brain. Some symptoms of a stroke could be sudden numbness or weakness of the face, arm or leg, especially on one side of the body; sudden confusion, trouble speaking or understanding; and sudden trouble walking, dizziness or loss of balance. If these symptoms occur, get emergency medical help immediately. Act F.A.S.T if someone you know is experiencing signs and symptoms of a stroke. F. (Face) Ask the person to smile to see if one side droops.A. (Arms) Ask the person to raise both arms to see if one drifts downward.S. (Speech) Ask the person to say a sentence to see if their words are slurred and to see if they

April 9, 2021
Bonitas – innovation, life stages and quality care

Making your medical aid benefits last

Around 9 million South Africans are members of medical aid schemes to ensure they have access to private healthcare.  As each new year begins, members start with a clean slate, with new benefits and replenished savings. However, across the industry, members often complain that their benefits seem to ‘run out’ early on in the year. If you manage your medical expenses correctly you can avoid out-of-pocket expenses and limit the possibility of running out of benefits.   Here are 8 tips from Lee Callakoppen, Principal Officer of Bonitas Medical Fund, on how to stretch your medical benefits to maximise your value. 1. Use DSPs or networks Medical schemes negotiate preferential rates with providers – known as Dedicated Service Providers (DSPs) – who have partnered with them. This allows schemes to ensure that members get the best quality services at the most cost-effective rate so that benefits are optimised and the scheme at large is sustainable.  Using network doctors is an invaluable tool to helping make your medical aid last longer because it means you won’t be charged more than the negotiated amount. With over 6 000 GPs, Bonitas has the largest network in South Africa 2. Ask your pharmacist Buy over-the-counter medicine to treat less serious ailments and always, where possible, use generic medicine which has the same active ingredient, strength and dosage as the original brands and are just as effective. Pharmacists are able to provide sound medical advice on problems such as rashes, colds or illnesses that are not severe, simply ask!  3. Managed Care benefits Some schemes offer programmes to help you manage severe 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.  Carefully read through what your plan offers and choose wisely to make sure you find the right plan to suit your specific healthcare needs. 4. Go virtual Look out for telemedicine or virtual consultation options – which are cheaper.  A doctor will engage with you in a virtual video consultation on any medical issue and advise you on the most clinically appropriate steps for further care.  5. Be aware of consulting after hours In an emergency one has no choice but be aware that after hours consultations are expensive. 6. Know the facts  If you do need to be hospitalised and it’s not an emergency, ensure that the healthcare practitioner is on your medical aid’s DSP list. Talk to your doctor or specialist to find out all the facts in terms of what they will be charging and compare this to what your scheme will cover. If the difference is substantial, negotiate.  Approach your doctor and ask if he/she is prepared to adjust their fee. Alternatively, you can also check if there are other healthcare providers on your scheme’s network that will charge you a better rate. You can also avoid the unwelcome surprise of a co-payment or sub-limits by: Making sure you obtain pre-authorisation Making sure the medical practitioner uses the correct ICD-10 codes Getting a quote from the doctor, hospital and anaethetist and submit it to your medical aid to see which additional costs will apply (if any), what costs will be covered and how you can avoid these. 7. PMBs If you suffer from a Prescribed Minimum Benefit (PMB) condition, understand what benefits are provided as part of PMB conditions and use the service of a DSP to ensure your claims are paid from risk rather than from your medical savings account. 8. Keep moving One of the best ways to manage your health and the associated costs, is to live a healthy lifestyle and this includes getting enough exercise. Try different exercise routines and find one that works for you. Whether it is a regular short power walk, playing tennis or soccer, riding a bike or attending a yoga or pilates class, it will be beneficial to your mental and physical wellbeing. ‘Be informed’ says Callakoppen. ‘Your health is important, as are your finances, so take the time to research and understand the medical aid plan you’ve chosen. Even if you have not changed plans your benefits and savings differ year-on-year.  Make sure you read the information sent to you, including the fine print to understand the Scheme Rules fully. 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.’

April 1, 2021
Bonitas – innovation, life stages and quality care

15 Facts about the Covid vaccine

Although the vaccine rollout for healthcare workers has begun, myths and misinformation continue to circulate around its development, efficacy and just how the vaccine will help manage or mitigate the spread of the virus.  We asked Lee Callakoppen, Principal Officer of Bonitas Medical Fund for 15 facts about the vaccine. #1. How does the Covid-19 vaccine work? The Covid-19 vaccines produce protection against the disease by developing an immune response to the SARS-Cov-2 virus. The vaccine stimulates an immune response to an antigen, a molecule found on the virus and provides a supply of ‘memory’ T- and B-lymphocytes that help fight that virus in the future.   There are four types of Covid vaccines and they are all trying to achieve the same things: Immunity to the virus, reduction of symptoms if you are infected and being able to slow down or stop transmission.  South Africa is currently using the Johnson & Johnson (J&J) single dose vaccine but, regardless of which vaccine you receive, you won’t reach full protection until around two weeks after the vaccination. Your immune system needs this time to develop the antibody response. #2. It is safe? Yes. The vaccine that is being used in South Africa is safe and has been given to millions of people around the world. Although it was developed very quickly to save lives, it has gone through the same rigorous processes as other vaccines.  All medical products – including the Covid-19 vaccine – have to be approved by South African Health Products Regulatory Authority (SAHPRA) before they can be administered. #3. Are there any side effects?  Some individuals vaccinated with the J&J vaccine have experienced temporary, mild side effects. They are similar to those experienced with other vaccines, such as soreness at the injection site, muscle pain, chills and a headache.  Some also experienced fatigue and nausea. These are nothing to worry about and will disappear within a couple of days.  #4. Can you be allergic to the vaccine? People who are prone to allergies should inform the healthcare personnel administering the vaccine beforehand. This, in order for them to observed and monitored for a longer period after receiving the vaccine. However, if you experience a severe allergic reaction after getting a Covid-19 vaccine, vaccination providers – or your healthcare provider – can provide care rapidly and call for emergency medical  #5. Can you get Covid from the vaccine? No. None of the Covid-19 vaccines contain the live virus that causes the coronavirus. The J&J vaccine uses a harmless, modified form of the common cold virus in humans, called adenovirus. The vaccine will help your immune system fight the virus but will not infect you with it. #6. How effective is it? No vaccine is 100% effective but fortunately, the emerging data on Covid-19 vaccines have a high efficacy, at least against some of the variants.   If a vaccine has 70% efficacy, it means a person vaccinated in a clinical trial is around two-thirds less likely to develop the disease than someone in the trial who didn’t receive the vaccine.  Due to the severity of the virus, a 50% efficacy threshold was set for Covid-19 vaccine. #7. Am I forced to have the vaccine? No. Having the Covid-19 vaccination remains a personal choice as confirmed by President Cyril Ramaphosa.  #8. Do I need the vaccine if I have already had Covid-19? Yes, the advice is that you should still be vaccinated even if you have had Covid-19 or if you have a positive antibody test.  Research indicates that the natural immunity from having Covid does not last which means the best way of fighting the virus is a combination of being vaccinated and following the protocols. #9. Will I be immune after the vaccine and will this be forever?  It is too soon to know how long the vaccine will last as it is still being researched.  Of the people who have received the vaccine, we know that they have been protected from Covid-19 for at least 4 months.  The risk of Covid-19 infection in vaccinated people cannot be completely eliminated.   #10. Can you have the vaccine if you are pregnant or breast feeding? None of the vaccine trials included pregnant individuals, so direct knowledge is limited. However, the Centres for Disease Control and Prevention (CDC) as well as a number of other medical organisations agree that any of the currently authorised Covid-19 vaccines can be offered to people who are pregnant or breastfeeding.  #11. Is it safe to be vaccinated if I’m living with HIV/Aids? Yes. There is some evidence that people living with HIV may be more vulnerable to developing severe Covid-19 symptoms and so getting vaccinated is even more critical if you are HIV positive. The Covid-19 vaccinations are the most powerful tools available to help prevent severe disease due to SARS-CoV-2.  The vaccines are not live and are safe for people with compromised immune systems.  It’s too early to tell how effective the vaccines will be at reducing transmission of Covid-19, but we do know that they are effective at preventing severe disease and death. #12. What does herd immunity mean? Herd immunity occurs when a large part of the population becomes immune to a virus, through vaccination or infection.  South Africa’s Department of Health (DoH) is aiming to vaccinate 67% of the country’s population against Covid-19 – this equates to around 41 million people – to achieve herd immunity and slow down the rate of transmission of the virus. #13. How does the vaccination process work? Everyone over the age of 18 will be vaccinated in line with the Government’s Covid-19 vaccine roll out plan.  You have to be registered on the national Electronic Vaccination Data System (EVDS) and then a 3-phase approach (starting with healthcare workers) is being adopted to ensure there will be enough vaccines to meet the demand.   #14. Can you elaborate on the EVDS? The EVDS is based on a pre-vaccination registration and appointment system. Individuals have to

April 1, 2021
Bonitas – innovation, life stages and quality care

Hospital Plans vs Hospital Insurance: Knowing the difference

In times of economic pressure we all relook our monthly expenses to see where we can save on costs but having access to quality healthcare remains a priority – even more so during a global pandemic.  Hospital insurance may be cheaper than medical aid hospital plans but is definitely not the same product. We asked the Principal Officer of Bonitas Medical Fund, Lee Callakoppen, to help us understand the two different products offerings. Regulation ‘Firstly, before I take you through the benefits and possible shortfalls of hospital plans as opposed to hospital insurance, it is important to point out that hospital plans are part of the offerings provided by medical aids. This means the product is regulated and overseen by the Council of Medical Schemes and in accordance with the Medical Schemes Act 131 of 1998. Hospital insurance (or medical insurance) is part of the umbrella term, health insurance and includes hospital insurance, hospital cash back plan and gap cover. Hospital insurance is not part of a medical aid but is governed by the Financial Services Board (FSB) and the Long-term and Short-term Insurance Act,’ explains Callakoppen. Medical Aid Hospital Plans   A hospital plan provides you with basic, yet important medical cover. The product differs from scheme to scheme but in essence this plan is offered by a not-for profit medical scheme and will cover you in hospital for emergency and planned procedures In the case of Bonitas – you also get access to some additional benefits for wellness and preventative care The hospital plan ensures that when you are admitted into hospital for a procedure or due to an accident or illness, your expenses are covered – within the limits set by your particular plan There are 27 chronic conditions that all medical aid plans must cover, so the hospital plan also covers these which are known as Prescribed Minimum Benefits (PMBs)  This type of plan does not cover you for other day-to-day medical costs like visits to the doctor, specialist or medicine  It is tax deductible Hospital Insurance Hospital insurance is not a medical aid, it pays you for the time you spent in hospital but not for the treatment you receive It provides cash benefits depending on the number of days you are in hospital due to illness or an accident  The insurer pays the money directly to you, you are able to use the money however you please – to pay for daily household costs or the hospital, doctor and specialist bills  This often seems more attractive than a hospital plan and has a cheaper monthly premium however, the daily amount you receive is often way below the medical expenses incurred while in hospital It is governed by the Short or Long-term Insurance Acts Does not cover Prescribed Minimum Benefits (PMBs) May include Personal Accident risk cover such as disability and loss of limbs, inability to work, salary protection, death and/or funeral covers Is not tax deductible The limitations of hospital insurance  It is a set amount which might not cover your hospital or medical bills, leaving you financially short and, in some cases, has a waiting period  New regulations state that pay-outs are limited per insured life, per hospital stay with an annual limit Typically people buy the policy that pays less than R1 000 per day If you have one of the top plans, the daily pay-out during your stay in hospital may sound like a lot of money however, it usually falls short of actual costs charged by hospitals, doctors and specialists  For example, a caesarean birth costs around R30 000. This can be much more if complications occur. Remember that hospital insurance companies are ‘for profit’ unlike medical schemes who are ‘not for profit’.  The recommendation by most financial advisors is that a hospital insurance product should be used in conjunction with medical aid, or hospital plan, as income replacement rather than medical aid cover. And what is GAP cover, how does it work? Callakoppen provides an update. Minding the gap At times there may be a shortfall between what the medical scheme pays and what the hospital or specialist charges. You are responsible for paying the difference There is an insurance policy called gap cover which you can take out to pay for this shortfall The amount you receive depends on your policy but there is an overall annual limit  Some gap cover policies have a waiting period for certain conditions Most people usually take gap cover together with a medical aid hospital plan  It is important to know that gap cover, like hospital insurance, is an insurance ‘policy’ and is registered as Short-Term insurance policies Gap cover premiums are not tax deductable ‘There has been a growth in health insurance products over the past few years and they appear to provide medical cover, but actually don’t,’ says Callakoppen.  If you choose to take out health insurance, do so as complementary to medical aid, not a substitute. ‘My advice: Shop around to find the best plan that covers your health needs and suits your pocket.  A number of Low Cost Benefit Options have been introduced by Medical Schemes – these offer more affordable plans that give you peace of mind in terms of access to quality healthcare.  Interrogate the benefits you receive on the plan you are considering versus the monthly contributions but, above all, never compromise on your health.’

March 18, 2021
Bonitas – innovation, life stages and quality care

Trimester two overview

Your second trimester begins in week 13 and ends at week 28. During this time your morning sickness will ease off, and initially your baby will be small enough that your body won’t be in too much discomfort, earning this trimester the nickname of the honeymoon period of pregnancy. During this trimester you’ll probably tell your family, friends and employees you’re expecting and your tummy will begin to show – time to upgrade your wardrobe! Your body during your second trimester During the second trimester the pregnancy you’ll hopefully notice that your morning sickness is easing up and your energy levels should begin to rise. While you will be feeling better don’t put pressure on yourself to exercise or socialise more than you’re comfortable with. This trimester your baby bump will go from barely noticeable to one that you may struggle to hide. Embrace your changing body and adapt your exercise plan to accommodate your baby, prenatal yoga and pilates classes are a great way to stay in shape, meet other moms-to-be and prepare for labour and delivery. A growing belly and breasts, Braxton Hicks contractions and leg cramps are all common pregnancy symptoms you may experience during this trimester. Not only this but you may experience dental issues, sore and swollen feet, and an achy back and/or pelvis. Your baby’s growth during the second trimester Your little one does lots of growing during your second trimester, and during this time you’ll begin to feel them moving around inside your belly (this is also known as quickening). Not only this, but during trimester two your baby’s ears develop to the point that they can hear your voice and other external sounds.  During the second trimester your baby’s eyes and ears become more developed and you’ll soon be able to find out their gender on an ultrasound (if you want to!). Your baby’s muscle tone is also improving, they’ll be swallowing amniotic fluid and their sucking reflex will develop – they may even suck their own thumb. Important things to note during the second trimester At week 19 to 20 you’ll have an anatomy scan. In this scan your doctor will be able to see how your baby is developing, and if there is anything unusual that would be cause for concern. During this scan the doctors will also be able to tell you the gender of your baby – if you decide to be told you can start thinking of baby names! This trimester is also a good time to decide how and where you’d like to have your baby. Decide on if you like a hospital or home birth, and start putting together a birth plan.

March 16, 2021
Bonitas – innovation, life stages and quality care

When the stomach turns .. tummy bugs or COVID-19?

As South Africa nears the end of the second wave of Covid-19 and braces for a third, a stomach bug is circulating and spreading in schools and the community.  Dr Morgan Mkhatshwa, head of operations at Bonitas Medical Fund, discusses the signs and symptoms of a stomach bug and common gastrointestinal (GI) viral infections versus the GI symptoms from Covid-19.  He says, ‘Although the period between November and May usually coincides with an increase in diarrhoea and pneumonia cases, according to the MMC: Community Services and Health, Zahid Badroodien, it is significantly reduced with a 29% decrease in cases and a 15% decrease in hospital admissions. The decline is partially attributed to the increased adherence to health protocols for Covid-19 like hand-washing, sanitisation and wearing masks.’ However, the recent tummy bug that is circulating, is proof that the virus is still around, Dr Mkhatshwa talks about common GI viral infections and GI symptoms associated with Covid-19. What are the symptoms of a tummy bug?  Stomach bugs (or stomach flu) are known as viral gastroenteritis and are characterised by the following symptoms: Diarrhoea  Abdominal cramps  Nausea  Vomiting  Fever  Thirst  Joint aches  Headache  General malaise How long does a stomach bug last? People typically develop stomach bug symptoms within 24 to 72 hours of being exposed to the virus. While most cases resolve in three to four days, it’s not uncommon to feel unwell for up to a week. How do I know if it’s food poisoning or a stomach virus? The symptoms of food poisoning and a stomach virus are very similar. However, food poisoning symptoms develop in as little as a few hours. Most people suspect food poisoning when symptoms develop shortly after eating food which may seem questionable. Covid and gastroenteritis Research consistently shows that approximately 10% of adults with Covid-19 report GI symptoms such as nausea, vomiting or diarrhea. Typically, patients will also have the more common upper respiratory symptoms that accompany Covid-19, such as a dry cough or difficulty breathing.  How do you tell the difference between Covid-19 symptoms and ‘stomach flu’? So, how do you know which one you’re dealing with if you’re experiencing, for instance, a fever, vomiting, and diarrhoea? ‘Unfortunately, it is not always easy,’ says Dr Mkhatshwa, ‘if you have respiratory symptoms, (particularly chest pain) and loss of smell or taste, it is pretty clear cut. However, GI symptoms can occur on their own with Covid-19.  A stomach bug also typically lasts only 72 hours while GI related symptoms with the coronavirus can last much longer.’ What should you do if you suspect the GI symptoms are in fact, Covid-19 related?  Consult your doctor – via phone or virtually – to discuss your symptoms and if he/she feels you are displaying signs of the coronavirus infection, they will refer you for a Covid-19 test.   How long are you contagious with a stomach bug? Stomach viruses are highly contagious and can spread quickly. People infected with a stomach virus are contagious from the moment they begin feeling ill and also for the first few days (up to 72 hours) after they recover. A stomach virus can spread in several different ways: Eating food or drinking liquids that have been contaminated with the virus Having direct or indirect mouth contact with an infected person or surface with the virus on it Unhygienic behaviour, such as not washing hands after toilet use, not washing fruits and vegetables before consumption The virus also inhabits the vomit and stools of people who have the infection How do you treat or get rid of a stomach bug? Supportive therapy that includes increased hydration, rest, electrolyte replenishment and medication for fever is usually all that is needed for viral illnesses.  This is because viruses do not respond to antibiotics and simply need to run their course. If the infection is caused by bacteria, like Salmonella, an antibiotic may be prescribed. Viral gastroenteritis will typically resolve within a few days or less without medication. However, hydration is vital to a speedy recovery and prevention of complications. Here are a few steps you can take at home to aid recovery from a stomach virus or food poisoning: Try not to eat any solid foods until you feel better Suck on ice chips or take small sips of water to prevent dehydration Avoid juices or other beverages with a lot of sugar or sweeteners that can make diarrhea worse Ease yourself back into eating. Start with bland, easy-to-digest foods, such as toast and rice. Stop eating if a feeling of nausea returns Avoid dairy, caffeine, fatty foods and sugar until you feel better You should be cautious of taking over-the-counter medications, unless advised by a healthcare provider, as some can worsen the infection When to treat it seriously and consult a medical doctor? Seek medical attention if you have any of the following symptoms: A bloody stool or vomit Are unable to keep liquid down for 12-24 hours Feel dizzy or  light-headed Have a fever above 40°C Are experiencing severe, unrelenting abdominal pain. Fortunately, thanks to the Covid-19 protocols which include wearing masks, social distancing and the washing and sanitising of hands the incidence of stomach bugs has been reduced. However, it is a virus and you may still be susceptible but remember it will run its course and you will recover. During the time you are experiencing symptoms rest, stay hydrated and stay away from others while you are still contagious.

March 10, 2021
Bonitas – innovation, life stages and quality care

Your second trimester – making the most of it

Your second trimester is from the beginning of week 13 until week 28, during this time your pregnancy will begin to show. However, you should feel like you have more energy than you did in trimester one. This is why this trimester is also nicknamed the honeymoon period of pregnancy – your baby isn’t big enough to make you uncomfortable and your pregnancy hormones should have eased up.  During this time there are one or two things that you can keep in mind to make the most of this time while you’re feeling better, and to ensure that your baby (and you) are kept healthy and happy.  Childbirth classes, preparing your mind and body  Even if this isn’t your first baby, childbirth classes can help prepare you for what is to come. If you’re feeling anxious about labour and birth, these classes will help ease your worries, by informing you what is to come and how best to manage your mind and body coming up to, during birth and after birth.  Prenatal exercise and a healthy lifestyle Stay fit and healthy during your pregnancy is important to both you and your baby. What you eat and regular exercise are both ways in which you can provide needed nutrition to your baby and keep yourself healthy.  Low impact exercise, such yoga, swimming, walking and prenatal pilates can help improve your sleep, and increase your strength and muscle tone. Keeping active can even have the added benefit of helping prepare your body for labour and birth.  Maternity wear and staying comfortable  Not only is learning about your pregnancy and staying healthy essential but staying comfortable is also important. The second trimester is generally when your tummy will start looking and feeling bigger,  so invest in some trousers that have more give in the waistline. Luckily certain fashion items, such as flowy dresses and layered knits, may even mean you can still keep using your pre-pregnancy clothes.

March 9, 2021
Bonitas – innovation, life stages and quality care

Covid and flu – should you still have the flu shot?

Dr Morgan Mkhatshwa, Head of Operations at Bonitas Medical Fund unpacks the differences and similarities between ‘flu’ and Covid-19, how it affects your body and offers compelling reasons why you should consider getting the flu vaccine this year.  Every year, seasonal influenza (flu) kills around 11 500 people in South Africa alone. To date, Covid-19 has resulted in around 50 000 deaths in South Africa. While the true mortality of Covid-19 will take some time to fully understand, the crude mortality ratio (the number of reported deaths divided by the reported cases) is between 3-4%. For seasonal flu, mortality is usually well below 0.1%. However, mortality is to a large extent determined by access to and quality of health care. How has Covid-19 impacted on the flu virus? The Covid-19 pandemic has, however, had a significant impact on the 2020 flu season where decreased flu activity has been reported. This is most likely related to lockdown and additional hygiene measures. Bearing in mind that The World Health Organization (WHO) has recommended flu vaccines for 2021, circulating flu viruses evolve constantly so an accurate prediction for the upcoming season is challenging. Should you still have a flu vaccine in 2021?  Dr Mkhatshwa recommends you do. Flu vaccines have been shown to reduce the risk of influenza illness, hospitalisation and death. Not only will flu vaccinations reduce the risk of getting flu but is an important conservation measure for scarce health care resources which remains a concern with the ongoing the Covid-19 pandemic.   The flu vaccine should be given sufficiently early to provide protection for the coming winter. A protective antibody response takes about 2 weeks to develop. As there is limited evidence on the safety and effectiveness of receiving these vaccines simultaneously, Dr Mkhatshwa recommends waiting at least 14 days between having the Covid-19 and flu vaccinations.  How are Covid-19 and flu viruses similar?  WHO says, ‘Firstly, Covid-19 and influenza viruses have a similar disease presentation. That is, they both cause respiratory disease, which presents as 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 good respiratory etiquette (coughing into your elbow or into a tissue and immediately disposing of the tissue), are important actions all can take to prevent infection.’ What are the essential differences between Covid 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. Influenza C is less common and produces milder disease. WHO says there are important differences between the two viruses and how they spread. This has important implications for the public health measures that can be implemented to respond to each virus.  The two are essentially different viruses with SARS-CoV-2 being a newly discovered coronavirus that causes Covid-19.  The speed of transmission This is an important point of difference between flu and the coronavirus.  Influenza has a shorter incubation period and can spread faster than Covid-19. Further, transmission in the first 3-5 days of illness, or potentially pre-symptomatic transmission, is a major driver of transmission for influenza. Although with Covid-19, people can be infected by someone 24-48 hours before the onset of symptoms – this is not the major driver of transmission.   The severity of illness While the range of symptoms for the two viruses is similar, the fraction with severe disease appears to be different. For Covid-19, data to date suggest that 80% of infections are mild or asymptomatic, 15% are severe, requiring oxygen and 5% are critical infections, requiring ventilation. These fractions of severe and critical infection would be higher than that of flu. Who is at risk? The Department of Health (DoH) together with the National Institute for Communicable Diseases (NICD) targeted the following groups for the 2021 campaign: Healthcare workers Individuals age >65 years  People with comorbidities like heart disease, diabetes or lung disease  Pregnant women  People living with HIV and AIDS  What are the signs and symptoms? In terms of symptoms, Covid-19 and flu can have varying degrees of signs and symptoms, ranging from none (asymptomatic) to severe symptoms. Common shared include: Fever or feeling feverish/chills, cough, shortness of breath or difficulty breathing, fatigue, sore throat, runny or stuffy nose, muscle pain or body aches, headache, some people may have vomiting and diarrhea, though this is more common in children than adults. Other signs and symptoms of Covid-19, different from flu, may include change in or loss of taste or smell. A Covid-19 test will confirm the diagnosis. Does the flu shot give me a mild flu? According to the Centre for Disease Control (CDC), ‘A flu shot cannot cause flu. Flu vaccines given with a needle 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 shot are soreness, redness, tenderness or swelling where the shot was given. Serious allergic reactions to flu vaccines are very rare.’  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 chances of getting the flu and, if you do get it, it will be a great deal milder More importantly, by having the flu vaccine you will protect others, via what is called ’herd immunity’. Others may be vulnerable family members such as small babies and the elderly as well as those who are immune compromised. While the world focuses on Covid-19, social distancing, wearing a mask and hand washing or sanitisation can help protect you from both Covid-19 and flu.

March 4, 2021
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