With the growing burden of modern-day diseases and continued financial pressure experienced by employees, both of which have a direct impact on business productivity, South African employers are constantly searching for innovative solutions to address these very real issues.
So is there a place for alternative and affordable solutions that address primary healthcare services only, within a South African context? The answer is a definite yes, and it is increasingly clear that access to affordable, high-quality primary healthcare in the private sector can make our healthcare system more accessible to everyone. The Council for Medical Schemes (CMS) has also recently made provision for the formal design and delivery of such health insurance products to address these primary healthcare requirements.
There has been a proliferation of primary healthcare solutions of late. Therefore, in order to make them more accessible to employers and employees, it is essential that such solutions:
- be aligned to the recent legislative allowances,
- provide real day-to-day cover,
- focus on chronic disease diagnosis and treatment,
- include special investigations,
- provide psychosocial medicine addressing both psychological and social aspects, and
- provide responsible hospitalisation for traumatic events.
As general practitioners (GPs) are the gatekeepers to accessing the abovementioned treatment value chain, a primary care product must also provide for:
- ease of access to GPs,
- GPs located in the right areas,
- a cashless member engagement, and
- dispense medication through practices where possible.
In addition, primary healthcare network providers should follow a responsible approach as to how they treat and remunerate their GPs, to ensure quality service delivery that is affordable for members. All of these services should be aligned and provide the member with a seamless and positive health experience and outcome.
Well-constructed and CMS-exempted primary healthcare solutions will provide South Africans with alternative access to private healthcare and should be a key consideration (in conjunction with medical schemes) when designing health-funding solutions for employers and employees alike.
Contact your Simeka Healthcare Consultant, on our Client Care line at 0860 122 340 or email info@simekahealth.co.za for a free quotation, or if you require a needs analysis.