By: Dion Mhlaba, Chairman of Wesmart
A lack of access to primary healthcare due to financial constraints is leaving millions of South Africans vulnerable, resulting in more severe health conditions and illnesses that are only discovered once they are at crisis stage.
While quality primary health care will ensure “early detection” in most cases and provide a solid platform for a person’s health needs throughout their lifetime, the vast majority of South Africans struggle to afford prevention, treatment, rehabilitation and in some instances, palliative care for even basic healthcare needs. It is a well-known and documented fact that about 80% of South Africa’s population depends on the availability and access to the public sector’s primary care services, but their ability to engage and consult is often restricted by the sheer number of patients, poor resourcing and facilities and clinic operating times that don’t cater for working-class people.
“Currently, millions of South Africans make use of an overburdened public healthcare system for their healthcare needs such as GP visits, optometry, dentistry, pathology or radiology. This system is typically limited and often fails to provide even the most basic of primary health care services. It is not uncommon to hear of employees taking an entire day off work simply to see a doctor at a public facility or to refill a chronic script, only to be turned away because a healthcare practitioner is over-subscribed or medical equipment isn’t available. Faced with these challenges, many people postpone going for annual check-ups or health screenings, if at all. Herein lies the challenge, as having access to primary healthcare services helps doctors detect an illness early, and early detection can minimise the severity of an illness and possibly even save a life. The financial and emotional impact of a serious diagnosis of illness for individuals and families is massive, not to mention the repercussions on employment and productivity for employers,” says Dion Mhlaba, Chairman of Wesmart.
Wesmart Financial and Administration Solutions provides a wide range of Health Insurance options and holds an exemption in terms of the Demarcation Regulations from the Council for Medical Schemes (CMS) under exemption number DM1122. Wesmart is underwritten by GENRIC Insurance Company and the focus is on offering options to individuals as well as SMME and corporate employer groups.
For millions, the cost of medical scheme membership is simply out of reach, however health insurance provides an invaluable and affordable alternative to access quality private healthcare, particularly at a primary care level. The benefit of health insurance is that it provides a range of options on cover from basic primary care only options (which are the most popular), hospital only options as well as more comprehensive options combining both in and out of hospital benefits. Health Insurance keeps the premiums affordable through various interventions and protocols as well as by working with a designated network of healthcare providers, providing cover for defined events and conditions, and by ensuring that acute and chronic medication adheres to a set formulary.
“Without some form of access to health professionals, many people simply avoid obtaining even the basic health checks and screenings due to cost and access factors. They may languish for days, if not weeks with a health ailment as they may not have the funds available for a doctor’s appointment and treatment or cannot afford the time off work and frustration of trying to access public services. They thus often miss out on early detection of physical changes that could be indicative of specific diseases such as diabetes, hypertension, heart disease and cancer. In so many instances, by the time these people present at hospitals with complications related to manageable health conditions, they often face devastating health and financial consequences. In the case of diabetes, amputations due to diabetic neuropathy and lack of basic healthcare are becoming common place, while late stage cancer diagnoses often mean poorer prognosis and chances of survival,” adds Mhlaba.
Health insurance provides an alternative for cash-strapped consumers needing to access quality private healthcare quickly and affordably, thereby providing consumers the ability to better manage their health circumstances more proactively, allowing for a better quality and healthy life. With healthcare insurance, consumers can access a defined network of private healthcare providers, including specialist doctors where referred by a GP, schedule an appointment and get access to the care needed.
Health Insurance increasingly becoming part of employee benefits offerings
Health Insurance has also become an increasingly important feature in the employee benefits landscape as private medical scheme membership becomes increasingly unaffordable for a large segment of South Africa’s working class and employer groups.
“For many employees, their first exposure to the concept of financial and healthcare planning will happen in the workplace. In this scenario, the employer is the door opener for many employees to insurance solutions that create greater future financial and health security for employees and their families. In the current struggling economy, many South Africans also face high levels of debt, and it’s a moot point whether employers can sustain the pace of increased workplace demands without more support for financially strapped employees. Given this scenario, it’s obvious that being able to offer healthcare benefits like health insurance for lower income workers – who would typically rely on the public health sector – provides a massive safety net where employees can access quality healthcare – and the peace of mind and productivity gains is also a win-win for all concerned.
“By adding health insurance to the employee benefits basket for employees who would typically not be able to afford private medical scheme membership, employers get to help remove or at least mitigate employees’ anxieties about protecting their families in a health crisis – and at premiums that they could not obtain on their own, unless when accessed as part of an employee group scheme,” concludes Mhlaba.