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Bestmed Medical Scheme

In South Africa, providing high-quality health care is a constitutional requirement. As a result, the government has implemented a number of initiatives and programs to improve health care, efficiency, safety, and quality of delivery and access for all users, as well as important reforms in health policy and regulations to assure compliance in providing high-quality care.

Despite these admirable achievements, South Africa still confronts a number of obstacles when it comes to providing the best possible treatment. The only way to ensure that quality of care improves is to address these issues. Fewer errors, fewer delays in care delivery, increased efficiency, increased market share, and lower costs are all signs of improved quality care.

Addressing such challenges and endeavouring to make improvements in the delivery of care is Bestmed Medical Scheme. Bestmed is a not-for-profit, self-administered medical scheme registered with the Council for Medical Schemes and has been providing quality healthcare for over half a century across South Africa

The Scheme is highly regarded by its users with a proven track record of offering members value for money, access to an extensive network of healthcare providers, and wellness benefits to help you live your best life! Bestmed’s tagline ‘Personally Yours’ perfectly encapsulates what the organisation is all about.

A Legacy of Quality Healthcare

Bestmed Medical Scheme has been offering medical aid to South Africans since 1964. It is the largest self-administered scheme and the fourth largest open medical scheme in South Africa, caring for over 220,000 lives. Bestmed also has one of the most extensive service provider networks in the country, including over 16,500 healthcare providers and ancillaries nationwide.

Bestmed offers 13 structured medical aid plans, including hospital plans and comprehensive options, that are designed to suit different life stages and budgets. All benefit options include an excellent range of preventive care benefits. Bestmed also offers nine managed healthcare programs, as well as a wellness program called Bestmed Tempo, which is available at no additional cost to all beneficiaries regardless of their benefit option.

The Scheme’s 2020 and 2021 results in the South African Customer Satisfaction Index (SA-csi) placed Bestmed at the forefront of customer experience in the country’s medical scheme industry. The SA-csi is an independent international benchmark of customer satisfaction.

Bestmed was measured alongside five other large medical schemes using a multi-variate model. Weighted indices include perceived quality and value, customer expectations and satisfaction, customer complaint incidence and handling, and customer loyalty.

The Comprehensive offerings of Bestmed

Bestmed has solidified its Personally Yours service in the market and has now become one of the fastest-growing and most financially sustainable medical schemes in South Africa.

The Scheme is well-positioned to offer continuously relevant enhancements to its benefit option offerings and to remain committed to the membership’s day-to-day needs. As a self-administered scheme, Bestmed manages its costs prudently to ensure that the maximum percentage of member contributions goes towards paying claims and not administrative costs.

Apart from the comprehensive product offering, which caters to all life stages, Bestmed also offers nine managed healthcare programs, including an Oncology program, HIV/AIDS program, and a Diabetes care program.

Beneficiaries need only complete a free Health Assessment at a network pharmacy to unlock their Bestmed Tempo wellness program benefits, such as consultations with a Bestmed Tempo dietitian and a Bestmed Tempo biokineticist to assist them to live a healthier lifestyle. A range of group classes is also offered throughout the year to help encourage and support a healthier lifestyle, regardless of a beneficiary’s age and health status.

“We believe that it is not only our Personally Yours service to beneficiaries, but our health and wellness offerings that have helped Bestmed grow during the pandemic despite economic difficulties in South Africa,” explained the astute CEO and Principal Officer of Bestmed Medical Scheme – Mr. Leo Dlamini.

“During 2020, Bestmed was the only scheme in the top five open medical schemes in the country that showed membership growth. The Scheme grew by 2.4%, while the industry decreased by an average of 2.9%. The Scheme continued on its sustainable growth path during the 2021 year,” he added.

The Pandemic Dictate

The COVID-19 pandemic has changed the landscape of the medical aid industry. Medical schemes have had to respond with agility to several elements, including:

  • Extensive use of alternative service delivery models (virtual and home-based care)
  • Increased pressure on medical cover affordability is exacerbated by the economic environment. Many members opted for lower-cost options, and some had to terminate their membership.
  • Informed membership – members have become better informed about the cover they buy and how it satisfies their healthcare needs.
  • Realization of the fluidity of the claims profile and the impact it can have on the finances of a scheme. Although significantly higher costs and lower margins were predicted for the healthcare industry due to COVID-19, most medical schemes, including Bestmed, experienced a decline in overall claims, while contributions remained unchanged during the 2020 financial year. This resulted in higher reserves across the industry. This trend changed during 2021, and claims returned to normal, especially with the added costs of vaccines and the re-uptake of elective procedures that were previously postponed.
  • Unfortunately, the pandemic caused members to delay their routine visits and check-ups, which can result in reactive health management.

Riding the Tech Wave

The healthcare industry has gradually been changing with the deployment of modern technology. The alternative delivery models (virtual care), which were critical to ensuring the safety of members, were accelerated by the COVID-19 pandemic. Other technology-based changes have been tracking along for a while.

Bestmed takes a cautionary approach in that it doesn’t lead the industry in funding such technologies but is guided by locally available data and/or takes the cue from the regulator. While these advances in medical technology can shorten theatre times and length of stay in the hospital, the concurrent costs of funding such technology will be imposed onto our members in the form of higher premium increases – and we are not keen on doing such in a hurried fashion.

Integration of service offerings with smart devices and wearables in the deployment of wellness programs is another area in which healthcare funders, like Bestmed, are involved. Data management and analytics is another area that has seen the extensive deployment of technology. This includes the integration of technology systems with service providers to leverage costs and offer seamless services to the members.

Bestmed was the first medical scheme in South Africa to partner with a digital healthcare innovator to offer the Scheme’s network of general practitioners (GPs) an easy referral process.

Scaling the Future

Bestmed has already announced its enhanced benefits for 2022. The Scheme’s benefit limits exceed its price increase for a second year running, ensuring great value for money to its beneficiaries. Other enhancements to the product offerings include an over 20% increase in optometry benefits, reduced co-payments for all non-formulary chronic medicine, monthly premiums for only the first three child dependants, child dependants covered until 24 years and 26 years if registered as students, etc.

The Scheme will launch a low-cost benefit option in 2022. While this option is not the Low-Cost Benefit Option (LCBO) which the industry has been engaging the regulator about, it will come close to tapping into the LCBO target market.

Unlike the LCBO, which requires exemptions from Prescribed Minimum Benefits (PMB), Bestmed’s option will make use of innovative ways to provide extensive cover for members while managing the costs to ensure affordability. Through this new product and enhanced existing product offerings, Bestmed will continue to grow beyond 2022.

Another area of growth, given the strength of Bestmed’s balance sheet and strong customer satisfaction record, within which the Scheme expects to grow is through amalgamations with smaller schemes.

Bestmed also invests greatly in the training and development of its employees to ensure that they are equipped with the necessary tools, knowledge, and resources not just to meet but exceed service expectations, which drives member loyalty.

Word to the Wise 

When Insights Care magazine asked what advice would you like to give to the budding entrepreneurs and enthusiasts who wish to venture into the Medical Aid sector, Bestmed’s CEO, Leo Dlamini, had this to say –

The healthcare industry is dynamic and currently in a state of change. These changes include increasingly stringent regulation, deployment of new technologies, increasing healthcare and related costs, the convergence of product offerings, stagnant to declining market size, high customer expectations, and consolidation of medical schemes.

The ability to offer quality and affordable healthcare to members is a differentiator in the industry. It is the key to the growth and retention of members. The industry has two main cost drivers, namely member-related utilization, i.e., claims profiles (cost of hospitals, clinical practitioners, and medicines) and administration thereof (HR, IT platforms, office space, etc.).

Budding enthusiasts also need to be cognizant of the fact that despite harsh economic times and the pandemic, the healthcare sector is unfortunately plagued by fraud and abuse that cost medical schemes millions of rands each year. Fraud detection and mitigation across the medical schemes industry is fragmented, and medical schemes and managed care organizations need to turn to large data analytics to uncover patterns and trends to keep the issue of fraud and abuse under control.