Showing up for medical scheme members as SA resets

“‘In survival mode’ is no way to live,” says Josua Joubert, CEO and principal officer of CompCare Medical Scheme. “Yet looking back over the past 18 months and longer, many of us have perhaps settled into a reactive state. 

“As is the case with any industry, medical schemes are part of a system that is not without challenges. Healthcare costs that escalate beyond the rate of inflation, for example, can be a bitter pill to swallow. The implementation of NHI and the role of the private sector remains somewhat of a question mark. And dare I even mention the pandemic? A wild card against which we have most certainly all played our best.”

Joubert says proactive behaviour will determine the success of businesses, with a strong healthcare backbone to ensure the wellbeing of a productive workforce. A total reset is already upon us with dramatic changes in not only the expectations of employees but also their real-life experiences. 

Back to the drawing board

So, what is the ideal healthcare offering, one that not only offers value but is also sustainable? “Going back to the drawing board means reassessing what matters most. After all, value in healthcare equates to meaningful benefits for employees that provide support without having to dip their hands into their own pockets wherever possible,” says Joubert. 

“Realistically, many employees avoid getting the care they need because of the financial implications. Mental health, for example, is one of the most underfunded areas in global healthcare and, locally, the average medical scheme has poor psychosocial benefits. This can no longer be the case if we are to have a well-functioning workforce.” 

Mental health matters

Before Covid-19 the SA Depression and Anxiety Group reported taking about 600 calls for help a day. By September 2020, that number had increased to 2,200 calls daily. 

When purchasing medical scheme membership, tangible mental health benefits such as unlimited access to a 24/7 professional helpline with referrals for one-on-one counselling when required, should not be restricted to certain options. “This is a benefit all members on a scheme should have access to, and all employees from the boardroom to the factory floor. 

Delayed care 

“As far as unsettling statistics go, it would be difficult not to mention the impending wave of devastating late diagnoses from people having delayed regular check-ups, to avoid the doctor’s office during the pandemic, and reduce expenses,” he says.

With a global cancer prevalence of one in five people, according to the International Agency for Research on Cancer, Joubert says: “An unlimited oncology programme is essential but simply not enough — it’s the scheme that pays for preventive checks from risk rather than day-to-day benefits that are giving members real support.” 

Family benefits

“Many employees have families to worry about and applying a child rate on all scheme options until the age of 27 for students and those who are financially dependent, can provide some support,” he says.

Wellness benefits and children’s health benefits are no longer seen as nice-to-haves, says Joubert, as so many employees’ worlds have been turned upside down with working from home, children attending classes virtually and generally having to find a way to reset their own lifestyle. 

Active support in regaining and maintaining physical health with access to a fitness and nutritional programme, an assessment from a biokineticist and registered dietitian, an exercise prescription, a healthy eating plan and regular monitoring can go a long way to helping the stressed and strained person restore balance.

Children’s benefits that include an additional emergency room visit and unlimited GP visits for those under the age of six can offer some welcome financial assistance, while the option of an occupational therapy assessment, exercise prescription programme and healthy eating plan for children can provide the boost that a tired young family needs.

Financial stability

“And of course, the money matters,” he says. “Yes, you can choose a medical scheme that is implementing contribution increases gradually each year or one that is deferring them to later in the cycle. Perhaps this will be at a time when your employees’ savings are running low or perhaps it won’t. Kicking the can down the road is a strategy. The question is whether it’s the right one for your business and your employees.

“Ultimately, it’s the job of your medical scheme to ensure that all employees have access to the care they need whenever they may need it. The SA workforce is taking strain and medical schemes need to be prepared. You need a scheme that is ready to show up,” says Joubert. 

This article was paid for by CompCare Medical Scheme.