GPs vs. specialists: what medical aid members should know

12 Sep 2013

Most parents would agree that they only want the best for their children, including making sure that they receive access to quality healthcare. As the year progresses, many medical scheme members start feeling the pinch of depleted medical savings and exhausted day-to-day benefits, which ultimately impacts on providing their children with the level of care that they would like.

"Healthcare can be a big part of your budget and it is important to use your available medical aid benefits in the best way possible," says Varsha Vala, Health Specialist at Momentum Health. "We often see members going straight to a specialist before consulting their local healthcare practitioner. In the long run, visiting your GP first can save you money and still provide you with the same health outcomes."

Day-to-day

While medical specialists do play an important role, most of your daily health needs and routine check-ups can be provided by your local GP or clinic sister. Similarly, GPs are equally equipped to administer baby immunisations at a fraction of the cost that a paediatrician would charge.

General practitioners are trained to take care of your general healthcare needs and will refer you to a medical specialist, such as a paediatrician, dermatologist or ophthalmologist, in cases where a greater level of expertise is required. Specialist visits come at a higher price than GP consultations due to their specialised expertise in a particular field, which means that they may charge more per consultation than what is covered by your medical aid.

Good medical care for everyone is as much about preventing illness as it is about treating it and that requires careful observation over time, usually conducted or coordinated by your GP. Besides your GP and medical specialist, your local clinic sister and pharmacist are also able to provide you with excellent medical advice.

"Having an open relationship with your local GP or healthcare practitioner is vital to ensuring that your health is maintained, diseases are detected early and treated, which ultimately may help to keep you at an optimal state of wellness and reduce your healthcare expenses," says Vala.

Vala points out the following additional ways to help you save on your medical aid:

Make use of your wellness benefits: Wellness Programmes added onto your medical aid cover can support your wellness and health goals, by offering you reduced gym membership rates and even give you money back.
Match your medical aid to your needs: If you are a healthy young professional, you may not need the same type of cover that a family would. Make sure that you understand the various types of options your medical scheme has to offer and which of them best suits your lifestyle and health needs. If you are not sure, your financial adviser will be able to help you to determine the type of cover that best suits your health requirements and pocket.
Get yourself checked out regularly: By going for regular medical checkups, certain conditions can be diagnosed early on, resulting in treatment that is often for a shorter duration and more effective. The less time on treatment, the more money you save.
Befriend your pharmacist: Chat to your pharmacist about generic medicines. Generic medicines are just as effective as brand names and often work out much cheaper.
Know your network: Your medical scheme may specify a partner network of hospitals and GP's - be sure to use them. Using a doctor outside of your medical scheme's specified partner network could mean that your claim is only partly reimbursed, or rejected altogether.