Statistically by now, over half of South Africa's eight million medical aid members would have run out of their medical savings funds that cover day-to-day expenses, which may contribute to less effective disease management.
Mariska Fouche, spokesperson for Pharma Dynamics, one of SA's leading pharmaceutical companies says medical aid members who are faced with having to pay additional medical costs out of their own pockets, could limit their access to proper healthcare.
"When patients do not take medicines as they should, there is a primary cost to their health of the illness not being properly treated, but there is also a secondary health cost when the original problem worsens and gets more expensive or even impossible to treat effectively.
"Therefore it is vital that medical scheme members manage their medical savings funds better," says Fouche.
She offers the following advice:
- Familiarise yourself with your scheme's rules, in particular what expenses are paid from your benefits and what is paid out of your Medical Savings Account (MSA) to keep expenses in check. You can contact your scheme's helpdesk and a consultant should be able to provide you with the above information.
- Family members should know and understand the medical aid rules and annual limits and how much money each person has to spend on for example dentistry, eyewear, physiotherapy etc, and should try to stick to it.
- Be sure to keep track of how much of your medical expenses were paid out of your own pocket during the previous year in order to claim tax benefits.
- Most medical aids require you to register your chronic condition before payment is made from your 'benefits'. If not registered you will continue to pay from your MSA, so be sure to phone your medical scheme to find out if your chronic illness is a Prescribed Minimum Benefit (PMB) condition. You may be required to submit signed forms from your GP or specialist confirming your chronic condition. Registering your condition with your medical aid will save you substantial sums of money as PMB conditions are covered in full by medical schemes (including Hospital Plans) in South Africa.
- Choose generic medicine, which is often half the price of brand name medicines. Generics contain exactly the same active ingredients as the original formulation and are identical to their brand name equivalents. Always ask your doctor or pharmacist for a generic option.
- Some doctors charge medical aid rates while others charge a much higher rate. Don't feel embarrassed to request medical aid rates or ask whether you qualify for a discount, especially if you pay up front.
- Avoid extra charges for emergency treatments, unless you have a real crisis on your hands. Always try to see your GP first than going to the emergency unit of a hospital or clinic otherwise you will end up paying substantially more. Don't miss appointments, which you inevitably will have to pay for and make the most of each doctor's visit by jotting down a list of all your health-related questions, including doctor's scripts, which many charge extra for when done over the telephone.
- Get rid of medicines that have expired or haven't been stored properly and ask your pharmacist to dispose of them safely. This will give you a good idea of what type of over-the-counter (OTC) medicines you still have in stock, so you don't buy duplicates.
- If you have applied all of the above steps and are still not making it on your medical savings then perhaps look at a different medical aid plan with a threshold benefit built into it. Once your medical aid savings are exhausted, there is a self-payment gap to get through, after which your scheme starts picking up the costs for day-to-day expenses again.
Fouche notes that the cost of medicine is increasingly becoming problematic for people who are already straining financially due to the current tough economic climate.
"To soften the blow for patients who do not have medical aid or a hospital plan, Pharma Dynamics has introduced the Patient Assist programme, which, in line with international best practice, absorbs part of the dispensing cost for patients.
"We have heard heart-breaking anecdotal accounts of patients attempting to creatively cut costs, such as an elderly couple sharing medication with the wife taking tablets one day and her husband the next. When treatment starts early and is maintained, serious long-term complications can be prevented.
"We take our role as a provider of medication very seriously and are excited to have devised Patient Assist to further help the medical and pharmaceutical professions in managing their patients, while also easing the financial burden on patients", says Fouche.
For more information on Patient Assist contact 0800 22 33 77 or log on to www.pharmadynamics.co.za.
