In light of the Constitutional Court ruling that a Medical Aid Scheme is obliged to fund the full cost of treatment for a list of 270 Prescribed Minimum Benefits and specifically for a list of 25 chronic conditions, I thought it appropriate to consider the “double barrelled” crisis facing Medical Aids.
In the first barrel are the fees charged by hospitals and specialists for those chronic conditions – and charge they do! With modern diagnostic machines like MRIs coming in at anywhere from R8000 to R15000 a shot, and specialists charging 3x Medical Aid rate, those charges escalate rapidly.
In the second barrel are the growing number of older members, 50 years and over. Figures vary, but at least 40% of a Medical Aid’s costs are incurred by about 6% of their members – those 50+, being treated simultaneously for 3 or more chronic conditions. The proportion of 50+ members is only going to rise as more and more Baby-Boomers approach and enter retirement – and as those already retired, live well into their 80s.
If they are not healthy, their cost to their Medical Aid will increase substantially. And that cost will ultimately have to be borne by the active, working, younger members – our kids and grand-kids.
To address this looming crisis, medical schemes are introducing Rewards Programmes to encourage their members to become, and stay, physically fit. Unfortunately most of those programmes are aimed at the younger members – weight training, circuits and endurance. The fitness of older members is then measured against criteria that are not age-appropriate. Vitality, for example awards many points for long distance running, cycling and swimming events – events that few, if any, older members would enter. And the Gyms – high tech, functional and intimidating. Who at 60, with 20 kgs of extra belly wants to exercise next to Venus and Adonis?
How then, to encourage and reward the elderly for staying healthy?
What points for gardening, for yoga, for walking round their neighbourhood, for aqua exercise, for being able to tie their own shoelaces, for losing some of those 20 kgs, for being able to open a screw-top jar, for being able to catch a rubber ball, for being able to walk under a chest-high cross-bar, for eating less, for eating well, for drinking less, for drinking 8 glasses of water a day, for getting 8 hours of sleep a night, for having an active group of friends, for contact with family, for babysitting and reading out aloud, for doing one’s own housework, for maintaining a hobby, for remembering a list of items from one day to the next, for being a member of U3A, for studying part-time? All of these are recognised as activities and behaviours that maintain the quality of life and health of the elderly.
Not much of this is funky or sexy, but if the Medical Aids are serious about the elderly staying healthy, then they need to start looking at more appropriate measures of physical and mental health.
Push-ups and sit-ups? Do me a favour – let’s identify some more age appropriate stretching, balancing and strengthening exercises. And let’s have a gym that is comfortable, where people are encouraged to talk to each other. Where people can socialise. Where the Personal Trainers are over 50 and exercise isn’t a competition.
If Medical Aids could be encouraged to build some of their rewards around the daily functional life of the elderly and if retirees could be encouraged to prepare properly for old age, the incidence and severity of old-age illness would be reduced. This would result in a major cost saving for the Medical Aid – and a more fulfilling old-age for their members.
So, how to get that encouraging conversation going?