Managed healthcare 'enables delivery'
MANAGED healthcare, despite all its problems, provides a structured approach to allocating scarce resources.
Tony Edmond, CE of Healthcare Management Services, the managed care arm of SA Druggists, says its success will depend "on achieving the balance between this and advocating patient interests in terms of quality, affordability and accessibility".
He says managed care can work in SA if managers embrace it and if employees assist in its development.
In the past five years healthcare expenditure almost doubled to R34.9-billion and increases in the costs of private healthcare were above inflation.
Edmond points out that between 1993 and 1995, the shortfall in underwriting of private healthcare schemes rose to 58% from 39%, "indicating that medical cover is increasingly beyond the means of many South Africans".
He says while managed care is not a cure-all for the problems in healthcare delivery, it offers an internationally proven way of managing facilities, resources, services and funding mechanisms in SA.
He also says a major benefit is that managed care is accountable because the delivery and outcomes can be measured. "This allows management to be certain its money is being spent productively" and gives employees the assurance they have access to appropriate care.
Figures from the US show that managed health care has had a profound and positive effect on the cost of medical cover, says Edmond.
"Specifically, these statistics show substantially reduced hospital expenses, lower premiums for managed care members and premium increases as low as 1.3% in 1996." States with a high managed healthcare penetration showed a decline of almost 12% in overall medical costs, while those with low managed health care penetration showed cost increases of 2.6%.
In SA the success of managed health care will depend on how it is implemented, says Edmond.
Part of the approach should be to empower general practitioners, who influence at least 70% of private healthcare spend in terms of medicine costs, specialist referrals and hospital admissions, yet receive only 10.4% of the total spend. "GPs have an essential role to play, both in preventing serious illness and keeping costs down."