Consider networks to manage medical costs

Consumers can help to keep their own as well as the medical scheme costs down if they make use of networks promoted by schemes. Peter Jordan, principal officer of Fedhealth believes that networks are all about achieving the best health outcome and consumers need to be more circumspect in what they are paying for and who they see.


"The reality is we do not have unlimited resources and many of the problems arise from over-servicing in the private sector and under-servicing in the public sector. There needs to be a drive towards encouraging members to utilize the networks which have been put in place more effectively," he says.


Jordan said that introducing networks has helped. In 2012, 82% of Fedhealth claiming beneficiaries accessed the Fedhealth GP network and 89% of the scheme’s claiming beneficiaries accessed the pharmacy network.


"We believe it is the scheme's responsibility to try and provide meaningful benefits to members which is why Fedhealth, on most options, provides unlimited access to GPs in the GP network. GPs are skilled at assessing the body as a whole and often pick up health issues that patients may not be aware of. This can lead to early prognosis and treatment without the need for a visit to a specialist. But in the event they do need a specialist, we have a growing specialist network base for them to access as well. "  


Fedhealth has 3 157 specialists contracted on its network, 4 333 doctors on its GP network and 1 679 pharmacies. “This is significant when you consider that hospital costs account for 45,3% of the claims submitted by its members, with another 19% going to specialists and 12% to general practitioners. Medicines account for 9.5% of claims," said Jordan.