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Medscheme, a subsidiary of JSE listed health company AfroCentric Group, are set to introduce a network structure aimed at reducing costs for cataract operations. The network will allow for a global fee model and assured quality of service for members of medical schemes.

“Through the network, members who need the procedure can have the assurance that the quality of care will be of a high standard, while the healthcare providers can be assured of the member’s affordability through the medical schemes. Overall, the costs are stabilised and this will in time lead to more access to care,” says Dr Lungi Nyathi, Managing Executive of Medscheme’s Clinical Advisory and Risk Division.

Nyathi explained that Medscheme has collaborated with ICPS (in full) to bring on board a network of ophthalmologists, which will oversee this bundled fee model for basic cataract surgery – which will go live on January 2021. “On behalf of Medscheme, ICPS will enter into officially approved agreements with healthcare providers to procure services within the global fee and the focus will be ensuring a fair professional fee while having efficiencies in the process”, Nyathi continues.

“As the country is moving toward National Health Insurance and with the challenges around providing access to healthcare in a sustainable manner together with a need for ensuring that healthcare providers are also able to sustain their practices and bring the much needed skills to society, we encourage all the role players to take part in this new approach and are open to ongoing engagements to further sustain healthcare in our society,” adds Nyathi.

Data presented in the Health Market Inquiry report back in 2018 illustrated that South Africa is one of the countries where admission rates for cataract procedures have been increasing above international trends. Due to the increasing numbers of procedures done and their rising costs, the total amount medical schemes are paying for cataract surgery is increasing at over 11% per year.

With an average cost of R30 000 per procedure and over 30 000 cases per annum, Medscheme has also observed large variations in cost across its data on cataract procedures. The data variations point to inefficiencies in terms of the value chain, which can be resolved through collaborations and models that are mutually beneficial to healthcare providers and customers alike.

“Initiatives such as this network, together with a collaboration with healthcare providers aimed at reducing costs are important in responding to the health burden of our country. World Health Organisation and the Department of Health information show that the proportion of visual impairment due to untreated cataracts is higher in low emerging countries including South Africa. By collaborating and finding sustainable interventions, we can prevent South Africa from lagging behind and ensure that the cataract surgery waiting lists are reduced” says Dr Nyathi.

“The complexity in our context is seen in the realities within the public and private sectors, which if not addressed, may impact on the sustainability of the sector. In the private sector costs are higher and are increasing, while in the public sector there are generally shortages of both skills and resource availability,” concludes Nyathi.



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