Historically case managers at state hospitals had little to do with private medical scheme members. But, as a result of the introduction of prescribed minimum benefits, many medical schemes have chosen state hospitals as their designated service providers to ensure affordability. This has resulted in a growing number of private medical scheme members being admitted to state hospitals.
According to the Council for Medical Schemes, South Africa boasts about 160 private medical schemes, covering more than seven million beneficiaries and a total annual contribution flow of around R35 billion.
Just one scheme alone, the medical scheme for government employees (GEMS), which is administered by MHG, has a membership where the previously uninsured component is more than 50%, according to Nick Rudston, Managing Director of MHG Administration.
Case managers play an important role in the managed healthcare chain. They provide clinical updates to the medical scheme/managed healthcare providers, who in turn use this data to ensure appropriate care for the member.
The DVD covers a comprehensive list of topics such as the need for correct pre-authorisation codes and verifying patient details to ascertain eligibility for treatment. This will assist the case managers with admission requirements relating to medical schemes, helping to improve the experience of patients who can be assured of professional care and handling during their treatment in state hospitals.
The DVD also addresses the duties of the case manager, admission officer, ward clerk and ward charge nurse, as well as how to manage and update hospital stay requirements, and how to communicate these details to the scheme.
Additional topics include managing patient discharge, authorising patients in the case of an emergency or after hours and managing patients with special needs.
Qualsa's Managing Director, Dr Khaya Gobinca, said the opportunity of working closely with the Western Cape Provincial Department of Health had been an extremely valuable one. “Healthcare as a whole in South Africa is shifting dramatically and we are proud of our role in producing this training DVD which will contribute towards government realising its vision of better healthcare for all,” he said.
Enquiries:Kusile Mthunzi-Hairwadzi
Corporate Affairs Executive
Metropolitan Health Group
Tel:(021) 480 4506
Susann Caminada
DRAFT FCB Redline, a division of DRAFT FCB South Africa
Tel:(021) 680-7604 / 082 775 4891
