Good health is also personal responsibility

They say when you have your health, you have everything. Few things can cost you more than losing your good health.

Business Live, 25 October 2016

We are more health-conscious than ever before. We try to get more exercise, make healthier food choices and educate ourselves on health issues. But we can't escape how expensive medical aid has become.

While everyone has the ability to make healthy choices, it is not always easy to do the right thing. To make a healthier choice, you must have healthier options.

I am grateful I live in a suburb working to ensure that we have safe places to walk and exercise; that our schools and work places provide healthy food choices; and in which we have access to health programmes.

The government and departments of health and education are joining forces to provide that same access at public schools. Changes in public policy such as a reduction in salt and sugar in food, smoking bans, access to antiretroviral treatment and the National Health Insurance being devised are aimed at ensuring that all South Africans have access to choices for health and live in a healthier society.

But we can all take charge of the way healthcare is provided to us by paying attention to some crucial matters.

We must see our general practitioners first when we are ill and not go directly to specialists and hospitals. Claims are up to 30% higher for patients who see more than one doctor, especially if the care is primarily specialist-driven. Even in developed countries, this is how excellent health systems works. Younger people must join medical schemes. People who are wealthier and more sick must pay for more expensive or more extensive medical scheme options.

We need to share information between all health providers, so that doctors don't have to repeat diagnostic tests. Medical scheme members often have to give consent for this to happen. Members must take control of their lifestyles and ensure that they get better - especially those with chronic diseases and after discharge from hospital. This will reduce the numbers of claims.

Doctors must claim according to the rates that schemes pay and must work together in teams. Patients must push for this to happen; it makes care so much simpler.
While salaries increase at least by inflation every year, the cost of food and medical scheme membership does not match this. The Health Market inquiry heard how medical scheme inflation can be more than 3% higher than inflation.

The high cost of medical scheme membership can be alleviated by a reduction in unhealthy and dangerous lifestyle behaviours; and an increase in preventive care, reducing the incidence of disease. There should be better integration of services including reducing the fragmentation of care where there is a duplication of services from one doctor to another or a health facility  to another. People should change the way they pay for healthcare to ensure that they buy care from doctors who have the best results. And the way benefits are designed should be changed to ensure that the system is sustainable and, hopefully, cheaper.

Employers should play their part because a healthy workforce is a productive workforce. Many employers subsidise medical aid contributions and are thus equally affected by increased costs.

Many employers have wellness programmes for their staff. Employers need to ensure these programmes are engaging, relevant, effective and that staff have time to access it. Some companies offer perks or rewards for employees who stay healthy knowing that they claim less for from their medical schemes, which keeps contributions low.
Industry and workers, health providers, consumers and the government must work together for a common solution.

Increases in medical scheme contributions was discussed extensively at the Health Market inquiry held by the Competition Commission. It was attributed first to the consumer price index, which usually contributes about 5.5% of the contribution increase.

Ageing contributes 0.5% to the increase. One of the foundations of medical schemes is that the young and healthy subsidise the elderly and the sick. Like savings, joining a scheme early helps everyone.

The burden of disease adds 2.6% to an increase. There are more people with chronic, lifestyle diseases and they are usually responsible for an increase in claims.
Buy-down behaviour adds 1.2%. If sick people buy cheap medical scheme options, there is not enough money in the kitty for all the claims to be paid.

Residuals such as new health technology, market concentration, fraud, waste and abuse add 1.1% to the increase in costs. Many of these cost drivers are not things that can be controlled by schemes alone.

Consumers, doctors, other health-care providers, hospitals, employers, the government and schemes have to work together to ensure that medical contributions do not keep increasing at a rate higher than wages. There is a saying that everyone prefers a solution benefiting their own interests, but this is no longer acceptable. It does take a village to improve the health of a family, community and the nation.