Estimated reading time: 4 minutes
As an established and reliable source of knowledge within the medical industry, Dr Francois van Niekerk, a Family Physician based in Newcastle, KwaZulu-Natal, discusses the differences and challenges when comparing the country’s medical sector and its cover to that of the United Kingdom. Furthermore, he educates Newcastillians on the differences between medical aids and hospital plans.
Begining the doctor explains, “After coming back to South Africa and Newcastle, having spent 12 years in the UK, it was quite a challenge to get my head around the way Medical Aids are funding healthcare in the Private Sector. As you know, the UK has universal health care, better known as the NHS, available for free to all their citizens at the point of care.”
This means everybody has full access to a high standard of medical care, irrespective of an individual’s income, status and social background. “It made our jobs as healthcare professionals so much easier. I did not have to make a choice between what type of test, treatment and surgery each individual patient was allowed to have. All got the same treatment. All had access to the same high standard of care,” affirms Dr Van Niekerk.
However, in South Africa, the doctor explains that the state sector is under-resourced, and the standard of care varies tremendously from hospital to hospital and province to province. “It is certainly not an appealing environment to work in.”
This leaves him and other medical professionals opting rather to establish a Private Practice, where doctors have more scope and control over the environment they provide to patients, with funding coming primarily via Medical Aids.
However, this comes with its own sets of challenges, pitfalls, and administrative burdens due to each Medical Aid Fund totting several options and plans, each with its own rules and benefits.
Dr Van Niekerk adds, “Even the medication you are allowed to prescribe differs from Fund, option and plan. This can be hugely confusing and frustrating to patients and doctors. It’s also a very time-consuming exercise to figure out what you can or cannot do for each patient.”
Another factor that comes into play with Medical Aids is whether or not you can afford it. The doctor explains this factor has become an even more pressing issue with people facing financial difficulties after losing their jobs or businesses during the pandemic. “The question is, how can you still afford a Medical Aid and avoid ending up in a dilapidated state hospital?” With this in mind, he enthuses it is becoming more popular to choose a Hospital-only Plan, which is cheaper than Full-cover Plans that give out hospital benefits. “The most expensive part of healthcare is hospitalisation and the treatment you receive in hospital, so it makes sense to cover yourself and your family for these.”
Dr Van Niekerk maintains it is imperative to check your budget while comparing the premiums of a full plan versus paying out of pocket for hospital expenses on a hospital-only plan. “When you’re young and fit, these should not amount to much at all. Maybe a few doctor’s visits with some medication, possibly an x-ray or blood test occasionally.”
In fact, most patients do not visit their doctor more than four times a year, supporting the justification behind a hospital-only plan.
Dr Van Niekerk emphasises doctors will usually be aware if you need to pay out of your pocket when looking at medical costs. They will help by giving you more cost-effective treatment options, aiding you to save even more. “It’s important to point out that most Hospital Plans offer chronic illness benefits out of hospital. This includes a couple of GP consultations a year to review chronic medication, and also covering the costs of these chronic medications.”
Considering this, the doctor states he believes more people will be able to afford Medical Aid cover if they look at the Hospital-Only plans. But Hospital-Only plans are not just for the young and fit. The doctor says he feels any age-group will benefit from hospital-only plans, as the medical costs for out of hospital treatments, visits, and investigations are only a fraction of those in-hospital costs.
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