What s on the Menu? DR JOHN JUTZEN SAPA Legislative History on Health Policy. Our Disease Burden. Can the State Deliver NHI?

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2 What s on the Menu? Legislative History on Health Policy DR JOHN JUTZEN SAPA 2017 Our Disease Burden Can the State Deliver NHI? Existing Private Sector & Options for the Future What is the impact on companies and their employees?

3 What s on the Menu? Legislative History on Health Policy Our Disease Burden Can the State Deliver NHI? Existing Private Sector & Options for the Future What is the impact on companies and their employees?

4 Health Policy Time Line 1992 Amended Medical Schemes Act 1995 ANC Health Policy Paper (SHI) POLITICAL CHANGE Medical Schemes Act, Taylor Committee: SHI Proposal NHI replaces SHI NHI Green Paper NHI White Paper v1 POLITICAL CHANGE 2007 PAYROLL TAX Public Sector 22 Years No Change Demarcation Regulations Gazetted Exemption Framework Low Cost Insurance LCBO Development - Medical Schemes 2017 NHI White Paper v2 PAYROLL TAX POLITICAL CHANGE 2019

5 What s on the Menu? Legislative History on Health Policy Our Disease Burden Can the State Deliver NHI? Existing Private Sector & Options for the Future What is the impact on companies and their employees?

6 Globally Burden of Disease DALY per 1,000 lives (Disability Adjusted Life Year) 515 SA SA 462 Global Average 230 W Pacific SE Asia Europe E Mediterranean Americas Africa Source: WHO; Econex

7 Disease Burden by Age High Income Countries Low-Mid Income Countries 60+ yrs, 35% 0-4 yrs, 5% 5-14 yrs; 4% 60+ yrs; 13% 0-4 yrs; 31% yrs; 56% yrs; 48% 5-14 yrs; 8% Source: WHO

8 What s on the Menu? Legislative History on Health Policy Our Disease Burden Can the State Deliver NHI? Existing Private Sector & Options for the Future What is the impact on companies and their employees?

9 NHI Figures Funding Single Payer Fund R200 bn Funding Shortfall - Econex, June Budget Treasury - R28bn 2015/16 Tax Revenue = R1.07 tn Providers NHI Pilot Sites (10) 19% of Posts Filled

10 Availability of Providers Citizens Per 1 Provider State Private Patient 16 years GP x Specialists x Dentists x Pharmacists x Psychologists x Source: Persal, Econex, van den Heever 10

11 INCOME National Health Structures Complementary Private Health Cover - Only for services not covered by Statutory Health Insurance Supplementary Private Health Cover - In Addition to Statutory Health Insurance Substitutive Private Health Cover - Instead of Statutory Health Insurance

12 NHI White Paper Proposals April 2017 July 2017 Jan 2018 April 2019? 2025 Medical Schemes Act Demarcation Regulations (Gap Cover) Exemption Framework PHC PMB Revision Amendment to an Act (5 years) LCBO 14 Acts to be Amended Policy Contradiction Medical Schemes 1 Benefit Option National Health Insurance Constitutional Challenge Financial Reality Change in Political Power

13 NHI Challenges Funding Problem Provider Shortage Massive Disease Burden Bureaucracy Will NHI survive 2019 Elections?

14 What s on the Menu? Legislative History on Health Policy Our Disease Burden Can the State Deliver NHI? Existing Private Sector & Options for the Future What is the impact on companies and their employees?

15 Tax Relief on Medical Schemes R64bn 2012 REDUCED DEDUCTION: R12,765 PA Current ± R20bn R15bn 2013 Sources: 2013 SARS Annual Report

16 Employer Subsidy on Medical Schemes 70% 60% 55% 60% 58% 50% 45% 50% 48% 44% 44% 46% 40% 30% 32% 20% 10% 0% % Of All Members Excl Gems Sources: 2014 and 2016 SARS Annual Reports

17 Payroll Integration Registered tax payers, 2016/2017 Taxable bracket Number Percentage Registered individuals with taxable income below the income-tax threshold R0 - R ,619,854 (48% of total 13.7mil individuals registered) R R ,583,046 36% R R ,733,463 24% R R ,071,798 15% R R ,990 11% R R ,722 7% Medically insured population estimated 4.5 million R R ,813 3% R R ,782 2% R ,578 1% Total 7,116, % Grand total 13,736,046 Source: National Treasury

18 Annual contribution R R Income and affordability based on 10% of income R R R R R R R- R0-R R70001-R R R R R R R R R R R R R R Contribution range Annual Income band Afforadble range

19 Scenario 1 Current NHI Policy Remains in Place Medical Brain Drain Limited Investment into Healthcare Constitutional Challenge Financial Constraints Very High Time Line Years Current NHI Policy

20 Scenario 2 Revised Current NHI Policy Policy Remains - Supplementary in Place Medical Brain Drain Schemes Act remains Unchanged Exemption Constitutional Framework Challenge Extended beyond 2019 No Financial Constitutional Constraints Challenge Single Time Line NHI -Fund 20+ Years Financial Constraints are Lower Inefficiency of Single Fund Current Revised NHI Policy

21 Scenario 3 Remove Revised NHI Policy - Supplementary Private LCBO - Private Sector remains Cover extends Unchanged to Employed Sector No Public Constitutional Sector Strengthed Challenge DHA (No Single Fund) Financial No Constitutional Constraints Challenge are Lowered Time Financial Line Constraints Years are Lowest Time Line 2-5 years Remove Revised NHI Expand NHI Private Policy

22 What s on the Menu? Legislative History on Health Policy Our Disease Burden Can the State Deliver NHI? Existing Private Sector & Options for the Future What is the impact on companies and their employees?

23 Our Landscape Range of Benefit Coverage 30% 70% Meeting the needs of all stakeholders ExecHealth Fusion (X) MyHealth Plus MyHealth Core MyHealth Vital Medical Aid MyClinic High AskNelson & Empowered Health Screenings Income Low

24 Fusion ExecHealth MyClinic Gap Cover Executive Wellness Programme On-site Healthcare Services Empowered AskNelson MyHealth Training Academy Employee Assistance Programme Primary Healthcare

25 Lives Under Management A B C Fusion Gap Cover AskNelson Employee Assistance Programme MyHealth Primary Healthcare lives lives lives

26 MyHealth Comprehensive Provider Network: Radiologists and Pathologists Nationwide Psychologists & Social Workers Pharmacies Dentists Optometrists General Practitioners 2 995

27 WORKFORCE = 1,000 HIV Chronic Psychosocial Total Days Lost 5,500 days 6,500 days 6,400 days 18,400 days AVERAGE SALARY = R7,000 8% of Payroll R6 million pa R560 per employee

28 Actual Experience in our Clients Absenteeism Productivity 8% 7% 6% 5% 55% Reduction in absenteeism 4% Group Life Insurance Premiums 45% Reduction in HIV death rates 3% 2% 1% 0% Pre EAP Post EAP 260 Families did not lose a loved one

29 Total Direct Financial Savings (2014) = R22 million Total spent on managing HIV (2014) = R5 million R R Group Life Savings Disability Savings Employee replacement savings Total saving Total Saving = R17 million R250 pepm R R R R Source: Annual Report

30 MyHealth Results Proactive Product Education Nominated a GP Wellness Days Chronic Disease of members trained on the product 62% of members have nominated at least 1 GP Screening 70% of members under patient management are compliant 98% 92% 2 in 3 members know their HIV status Average Member Service Scoring: 9.8/10

31 Developing Economies Global Health Expenditure (US$ trillion) 14 33% % % Developing Economies Developed Economies 0 Source: World Economic Forum,

32 Brazil World s 2nd Largest Private Healthcare Market 50 million lives 150 million lives World s Largest Public Healthcare System

33 Payroll Integration Registered tax payers, 2016/2017 Taxable bracket Number Percentage Registered individuals with taxable income below the income-tax threshold R0 - R ,619,854 (48% of total 13.7mil individuals registered) R R ,583,046 36% R R ,733,463 24% R R ,071,798 15% R R ,990 11% R R ,722 7% Medically insured population estimated 4.5 million R R ,813 3% R R ,782 2% R ,578 1% Total 7,116, % Grand total 13,736,046 Source: National Treasury

34 Annual contribution Income and affordability based on 10% of income R R R R R R R R R- R0-R R70001-R R R R R R R R R R R R R R Contribution range Annual Income band Afforadble range

35 MEMBER-CENTRIC Key Considerations for Primary Healthcare Access 1 Doctor Access = REAL Recognition by Provider = Prime Cure on membership card Acute Medication = Doctor Dispensed Chronic Medication = Courier or Pharmacy Pharmacy Network Social Challenges 2 Union Engagement = Buy-In Understand Social Challenges = Health Outcomes = ROI Chronic Patient Compliance > 92% Financial Limitations No Out-of-Pocket Payments

36 MEMBER-CENTRIC Key Considerations for Primary Healthcare Access 1 Doctor Access = REAL Recognition by Provider = Prime Cure on membership card Acute Medication = Doctor Dispensed Chronic Medication = Courier or Pharmacy Pharmacy Network Social Challenges 2 Union Engagement = Buy-In Understand Social Challenges = Health Outcomes = ROI Chronic Patient Compliance > 92% Financial Limitations No Out-of-Pocket Payments

37 CLIENT-CENTRIC Key Considerations for Primary Healthcare Hard Integration 3 Own the Value-Chain = Improved ROI Remove Cost Duplication Governance and Compliance OHS Regulatory Adherence Psychosocial Risk (EAP) Sustainability 4 Network Costs & Delivery - 30% Lower on GP costs Contract is with each Provider not IPAs Quality 98% First Time Access to Care and Treatment Measurable Outcomes

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