In the intricate landscape of healthcare governance, Annual General Meetings (AGMs) for Medical S... more In the intricate landscape of healthcare governance, Annual General Meetings (AGMs) for Medical Schemes play a fundamental role as a vital platform for transparent communication between administrators and members. Beyond formality, these meetings serve as a nexus for sharing critical updates, financial reports, and strategic plans. AGMs are crucial in guaranteeing transparency and accountability within medical schemes, actively involving members in the oversight of the healthcare community. However, the persistent challenge of limited member participation necessitates a closer examination of contributing factors and strategic measures for improvement. Key statistics on AGM-related expenditures in 2022 reveal insights into the financial landscape of medical schemes. Out of 71 schemes, 33 incurred AGM-related expenses totalling R29,2 million, covering 8.1 million lives. Challenges associated with AGMs include limited member awareness, accessibility barriers, and perceived irrelevance, prompting the need for strategic approaches. The paper suggests various strategies aimed at optimizing technology for enhanced communication, technological efficiency, the introduction of incentives, educational campaigns, and the promotion of a sense of community. Additionally, the paper presents a framework, influenced by insights from the COVID-19 era, with the goal of reinforcing the foundations of medical scheme governance. This framework aims to foster collaboration between administrators and members, contributing to the establishment of a resilient and responsive healthcare ecosystem. Overall, the study adds to the comprehension of AGM-related dynamics in medical schemes, offering practical recommendations and frameworks that can serve as guides for both scholarly research and practical implementations in the realm of healthcare governance.
This study delves into the complex challenges faced by health insurance providers, particularly w... more This study delves into the complex challenges faced by health insurance providers, particularly within the medical schemes sector, as they strive to develop effective marketing strategies. Emphasizing the pivotal roles of customer engagement, service quality, and marketing in shaping patient experiences and organizational success, the research underscores the intricate interplay between patient engagement, quality customer service, and strategic marketing within the healthcare sector. Key components for success are identified, including actively involved patients, positive interactions with healthcare staff, and a holistic approach that integrates customer engagement, service quality, and strategic marketing. The study acknowledges the growing influence of digital channels in healthcare customer engagement while addressing challenges such as regulatory constraints, the unique nature of healthcare as a public good, and the lack of standardized metrics for assessing marketing impact. The research extends its focus to the health insurance sector, particularly medical schemes, highlighting the distinctive features of health insurance products. It emphasizes patient engagement, complex sales processes, and coordination among multiple service providers. Social solidarity, community rating, and open enrolment principles are underscored as crucial in health insurance frameworks. The study further explores challenges faced by medical scheme members, emphasizing issues arising from inadequate customer engagement, lack of information accessibility, and complex administrative processes. The study concludes with an analysis of marketing expenditure trends within the medical schemes sector, identifying cases where ad-hoc strategies significantly impact budgets and organizational strategies. It calls for regulatory bodies and industry stakeholders to establish clearer guidelines and caps on ad-hoc marketing expenditures to mitigate potential financial risks. The research aims to contribute valuable insights for policymakers, healthcare providers, insurers, and marketers to enhance marketing strategies and improve healthcare outcomes.
e, Golden Ratio of Social Science and Education, 2024
This paper thoroughly explores the foundational principles governing population and target popu... more This paper thoroughly explores the foundational principles governing population and target population concepts within research methodology. It delves into the essential roles these concepts play in shaping the design and influencing the interpretation of research studies. Through an exhaustive analysis, it meticulously outlines the nuances that differentiate these two concepts, elucidating their respective contributions and implications across diverse research paradigms. Moreover, this paper underscores the importance of establishing clear definitions and boundaries for both the population and the target population. It emphasises how such precision is indispensable in guiding the formulation of effective sampling strategies, which are pivotal for ensuring the accuracy and reliability of study outcomes. Furthermore, it sheds light on how the clarity in defining these concepts significantly impacts the generalizability of research findings, elucidating how findings derived from a well-defined target population can be more confidently extrapolated to broader populations. In addition to methodological considerations, this paper investigates the ethical dimensions inherent in delineating population and target population. It underscores the moral imperative of accurately representing the groups under study, particularly ensuring equitable access to research participation and safeguarding against potential biases.
Background: Vision impairment (VI) affects people worldwide, and demographic factors like age are... more Background: Vision impairment (VI) affects people worldwide, and demographic factors like age are significantly linked to VI. Routine eye exams and other eye care treatments can detect and prevent common eye illnesses. However, many lack access to these services. Aim: This study’s major objective was to analyse the distribution and funding of eye care services by medical schemes in South Africa.
Setting: The study was conducted in the private sector in South Africa for benefits paid by medical schemes to optometrists, ophthalmologists and orthoptists.
Methods: A retrospective, longitudinal study of eye care services claim data from the Council for Medical Schemes (CMS) annual reports. The review period was 2020, and scheme-level data were gathered and analysed at the aggregated rather than benefit option level.
Results: In 2020, eye care benefits comprised 3.1% of total benefits paid; this proportion remained at the same levels throughout the review period. Closed schemes spent more per beneficiary per year than open schemes for optometrists, orthoptists and ophthalmologists. Self-administered schemes had 11% copayment for ophthalmology services, whereas outsourced schemes had less than 10%.
Conclusion: Optometrists had higher copayments than ophthalmologists and orthoptists. Medical schemes with capitated models had a lower average expenditure than other types of models, and the operating model affected expenditure; self-administered schemes spent less on optometry benefits when adjusted for beneficiaries. The study suggests reviewing eye care benefit funding models (risk vs savings), administration activities and managed care models for cost savings and health quality.
Contribution: This research contributes to the discussion and implementation of universal health insurance coverage through national health insurance in South Africa. The research shows that there are not enough eye care services in the public sector and that there are different funding gaps in the private sector.
Strategizing effective marketing initiatives while considering their cost-related factors require... more Strategizing effective marketing initiatives while considering their cost-related factors requires a targeted approach aimed at specific markets. The alignment of strategies with the intended markets is crucial to achieve desired outcomes. Research consistently emphasizes that successful marketing strategies should revolve around offering customers quality products at an affordable price point. However, the realm of medical schemes reveals a gap in comprehensively reporting marketing expenditure. Specifically, important attributes such as advertising expenditures and customer acquisition activities are not explicitly delineated, impeding a clear assessment of their value proposition for customers. The absence of comprehensive regulatory frameworks allows healthcare organizations to employ various marketing tactics, encompassing traditional advertising, direct marketing, digital marketing, and ad hoc marketing drives up marketing expenditure. Ad hoc marketing expenditure is notably prevalent in medical schemes, and a discernible trend of escalating expenditures in this category is evident. While this flexibility can be advantageous for organizations seeking to engage patients and expand their reach, it also opens the door to potential excesses and ethical concerns. Without adequate regulation, there is limited assurance that marketing activities align with ethical standards, respect patient autonomy, and prioritize responsible resource allocation. Moreover, the reporting limitations in the healthcare industry pose a formidable challenge. Healthcare marketing initiatives often involve nuanced and long-term objectives, such as building trust, enhancing patient education, and improving overall health outcomes. Measuring the direct impact of marketing expenditures on these multifaceted goals can be elusive, as traditional metrics may not capture the full spectrum of outcomes. This measurement gap hinders the ability to draw precise conclusions about the return on investment (ROI) of marketing efforts and their direct influence on membership growth. This research review aims to delve into the dynamics of marketing expenditures within medical schemes. The research objectives guide the analysis process, aiming to identify key factors driving marketing expenditures, understand variations in marketing strategies among different types of schemes, analyse the impact of marketing expenditures on growth and sustainability, and provide recommendations for optimal resource allocation. This study provides valuable insights into the challenges and implications of targeted marketing initiatives within the healthcare sector, particularly for medical schemes in South Africa.
This study delves into the complex challenges faced by health insurance providers, particularly w... more This study delves into the complex challenges faced by health insurance providers, particularly within the medical schemes sector, as they strive to develop effective marketing strategies. Emphasising the pivotal roles of customer engagement, service quality, and marketing in shaping patient experiences and organisational success, the research underscores the intricate interplay between patient engagement, quality customer service, and strategic marketing within the healthcare sector. Key components for success are identified, including actively involved patients, positive interactions with healthcare staff, and a holistic approach that integrates customer engagement, service quality, and strategic marketing. The study acknowledges the growing influence of digital channels in healthcare customer engagement while addressing challenges such as regulatory constraints, the unique nature of healthcare as a public good, and the lack of standardised metrics for assessing marketing impact. The research extends its focus to the health insurance sector, particularly medical schemes, highlighting the distinctive features of health insurance products. It emphasises patient engagement, complex sales processes, and coordination among multiple service providers. Social solidarity, community rating, and open enrolment principles are crucial in health insurance frameworks. The study further explores challenges medical scheme members face, emphasising issues arising from inadequate customer engagement, lack of information accessibility, and complex administrative processes. The study concludes with an analysis of marketing expenditure trends within the medical schemes sector, identifying cases where ad-hoc strategies significantly impact budgets and organisational strategies. It calls for regulatory bodies and industry stakeholders to establish clearer guidelines and caps on ad-hoc marketing expenditures to mitigate potential financial risks. The research aims to contribute valuable insights for policymakers, healthcare providers, insurers, and marketers to enhance marketing strategies and improve healthcare outcomes.
In the intricate landscape of healthcare governance, Annual General Meetings (AGMs) for Medical S... more In the intricate landscape of healthcare governance, Annual General Meetings (AGMs) for Medical Schemes play a fundamental role as a vital platform for transparent communication between administrators and members. Beyond formality, these meetings serve as a nexus for sharing critical updates, financial reports, and strategic plans. AGMs are crucial in guaranteeing transparency and accountability within medical schemes, actively involving members in the oversight of the healthcare community. However, the persistent challenge of limited member participation necessitates a closer examination of contributing factors and strategic measures for improvement. Key statistics on AGM-related expenditures in 2022 reveal insights into the financial landscape of medical schemes. Out of 71 schemes, 33 incurred AGM-related expenses totalling R29,2 million, covering 8.1 million lives. Challenges associated with AGMs include limited member awareness, accessibility barriers, and perceived irrelevance, prompting the need for strategic approaches. The paper suggests various strategies aimed at optimizing technology for enhanced communication, technological efficiency, the introduction of incentives, educational campaigns, and the promotion of a sense of community. Additionally, the paper presents a framework, influenced by insights from the COVID-19 era, with the goal of reinforcing the foundations of medical scheme governance. This framework aims to foster collaboration between administrators and members, contributing to the establishment of a resilient and responsive healthcare ecosystem. Overall, the study adds to the comprehension of AGM-related dynamics in medical schemes, offering practical recommendations and frameworks that can serve as guides for both scholarly research and practical implementations in the realm of healthcare governance.
This comprehensive review article thoroughly investigates the pivotal topic of healthcare service... more This comprehensive review article thoroughly investigates the pivotal topic of healthcare services' sufficiency for infants, encompassing prenatal care, neonatal care, vaccinations, and overall infant healthcare. With a focus on access, quality, and persisting challenges, the article underscores the critical need for infants to receive top-tier healthcare for optimal development and well-being. This research seeks to address critical gaps in infant healthcare through comprehensive investigations into prenatal and neonatal care efficacy, access disparities, and the impact of vaccinations. The objectives of this research review study were the assessment of the effectiveness of prenatal care, the identification and resolution of access disparities, the examination of the quality of newborn care, and the comprehension of the significance of immunizations. The significance lies in contributing to maternal and fetal health knowledge, advocating for equitable policies, and enhancing newborn health. The methodology involves a literature review, quantitative data collection for various secondary data, statistical analysis, case studies, and policy evaluations for a nuanced understanding of infant healthcare dynamics. The analysis underscores the need for a holistic perspective beyond single antenatal care (ANC) visits, revealing lower coverage of women receiving at least four ANC visits, especially in African countries. Despite the World Health Organization's recommendation to increase ANC contacts to a minimum of eight, global data reporting still centres on a minimum of four visits, signalling a potential delay in adopting updated guidelines and stressing the need for a more thorough and contemporary approach to antenatal care. In South Africa, significant variation among provinces is noted in vaccine expenditure per population under one year. Recommendations include conducting budget and financial expenditure analyses, ring-fencing vaccine budgets, and promoting broader health service utilization to address prenatal and neonatal care challenges comprehensively.
Strategizing effective marketing initiatives while considering their cost-related factors require... more Strategizing effective marketing initiatives while considering their cost-related factors requires a targeted approach aimed at specific markets. The alignment of strategies with the intended markets is crucial to achieve desired outcomes. Research consistently emphasizes that successful marketing strategies should revolve around offering customers quality products at an affordable price point. However, the realm of medical schemes reveals a gap in comprehensively reporting marketing expenditure. Specifically, important attributes such as advertising expenditures and customer acquisition activities are not explicitly delineated, impeding a clear assessment of their value proposition for customers. The absence of comprehensive regulatory frameworks allows healthcare organizations to employ various marketing tactics, encompassing traditional advertising, direct marketing, digital marketing, and ad hoc marketing drives up marketing expenditure. Ad hoc marketing expenditure is notably prevalent in medical schemes, and a discernible trend of escalating expenditures in this category is evident. While this flexibility can be advantageous for organizations seeking to engage patients and expand their reach, it also opens the door to potential excesses and ethical concerns. Without adequate regulation, there is limited assurance that marketing activities align with ethical standards, respect patient autonomy, and prioritize responsible resource allocation. Moreover, the reporting limitations in the healthcare industry pose a formidable challenge. Healthcare marketing initiatives often involve nuanced and long-term objectives, such as building trust, enhancing patient education, and improving overall health outcomes. Measuring the direct impact of marketing expenditures on these multifaceted goals can be elusive, as traditional metrics may not capture the full spectrum of outcomes. This measurement gap hinders the ability to draw precise conclusions about the return on investment (ROI) of marketing efforts and their direct influence on membership growth. This research review aims to delve into the dynamics of marketing expenditures within medical schemes. The research objectives guide the analysis process, aiming to identify key factors driving marketing expenditures, understand variations in marketing strategies among different types of schemes, analyse the impact of marketing expenditures on growth and sustainability, and provide recommendations for optimal resource allocation. This study provides valuable insights into the challenges and implications of targeted marketing initiatives within the healthcare sector, particularly for medical schemes in South Africa.
This study delves into the complex challenges faced by health insurance providers, particularly w... more This study delves into the complex challenges faced by health insurance providers, particularly within the medical schemes sector, as they strive to develop effective marketing strategies. Emphasizing the pivotal roles of customer engagement, service quality, and marketing in shaping patient experiences and organizational success, the research underscores the intricate interplay between patient engagement, quality customer service, and strategic marketing within the healthcare sector. Key components for success are identified, including actively involved patients, positive interactions with healthcare staff, and a holistic approach that integrates customer engagement, service quality, and strategic marketing. The study acknowledges the growing influence of digital channels in healthcare customer engagement while addressing challenges such as regulatory constraints, the unique nature of healthcare as a public good, and the lack of standardized metrics for assessing marketing impact. The research extends its focus to the health insurance sector, particularly medical schemes, highlighting the distinctive features of health insurance products. It emphasizes patient engagement, complex sales processes, and coordination among multiple service providers. Social solidarity, community rating, and open enrolment principles are underscored as crucial in health insurance frameworks. The study further explores challenges faced by medical scheme members, emphasizing issues arising from inadequate customer engagement, lack of information accessibility, and complex administrative processes. The study concludes with an analysis of marketing expenditure trends within the medical schemes sector, identifying cases where ad-hoc strategies significantly impact budgets and organizational strategies. It calls for regulatory bodies and industry stakeholders to establish clearer guidelines and caps on ad-hoc marketing expenditures to mitigate potential financial risks. The research aims to contribute valuable insights for policymakers, healthcare providers, insurers, and marketers to enhance marketing strategies and improve healthcare outcomes.
In the intricate landscape of healthcare governance, Annual General Meetings (AGMs) for Medical S... more In the intricate landscape of healthcare governance, Annual General Meetings (AGMs) for Medical Schemes play a fundamental role as a vital platform for transparent communication between administrators and members. Beyond formality, these meetings serve as a nexus for sharing critical updates, financial reports, and strategic plans. AGMs are crucial in guaranteeing transparency and accountability within medical schemes, actively involving members in the oversight of the healthcare community. However, the persistent challenge of limited member participation necessitates a closer examination of contributing factors and strategic measures for improvement. Key statistics on AGM-related expenditures in 2022 reveal insights into the financial landscape of medical schemes. Out of 71 schemes, 33 incurred AGM-related expenses totalling R29,2 million, covering 8.1 million lives. Challenges associated with AGMs include limited member awareness, accessibility barriers, and perceived irrelevance, prompting the need for strategic approaches. The paper suggests various strategies aimed at optimizing technology for enhanced communication, technological efficiency, the introduction of incentives, educational campaigns, and the promotion of a sense of community. Additionally, the paper presents a framework, influenced by insights from the COVID-19 era, with the goal of reinforcing the foundations of medical scheme governance. This framework aims to foster collaboration between administrators and members, contributing to the establishment of a resilient and responsive healthcare ecosystem. Overall, the study adds to the comprehension of AGM-related dynamics in medical schemes, offering practical recommendations and frameworks that can serve as guides for both scholarly research and practical implementations in the realm of healthcare governance.
This study delves into the complex challenges faced by health insurance providers, particularly w... more This study delves into the complex challenges faced by health insurance providers, particularly within the medical schemes sector, as they strive to develop effective marketing strategies. Emphasizing the pivotal roles of customer engagement, service quality, and marketing in shaping patient experiences and organizational success, the research underscores the intricate interplay between patient engagement, quality customer service, and strategic marketing within the healthcare sector. Key components for success are identified, including actively involved patients, positive interactions with healthcare staff, and a holistic approach that integrates customer engagement, service quality, and strategic marketing. The study acknowledges the growing influence of digital channels in healthcare customer engagement while addressing challenges such as regulatory constraints, the unique nature of healthcare as a public good, and the lack of standardized metrics for assessing marketing impact. The research extends its focus to the health insurance sector, particularly medical schemes, highlighting the distinctive features of health insurance products. It emphasizes patient engagement, complex sales processes, and coordination among multiple service providers. Social solidarity, community rating, and open enrolment principles are underscored as crucial in health insurance frameworks. The study further explores challenges faced by medical scheme members, emphasizing issues arising from inadequate customer engagement, lack of information accessibility, and complex administrative processes. The study concludes with an analysis of marketing expenditure trends within the medical schemes sector, identifying cases where ad-hoc strategies significantly impact budgets and organizational strategies. It calls for regulatory bodies and industry stakeholders to establish clearer guidelines and caps on ad-hoc marketing expenditures to mitigate potential financial risks. The research aims to contribute valuable insights for policymakers, healthcare providers, insurers, and marketers to enhance marketing strategies and improve healthcare outcomes.
e, Golden Ratio of Social Science and Education, 2024
This paper thoroughly explores the foundational principles governing population and target popu... more This paper thoroughly explores the foundational principles governing population and target population concepts within research methodology. It delves into the essential roles these concepts play in shaping the design and influencing the interpretation of research studies. Through an exhaustive analysis, it meticulously outlines the nuances that differentiate these two concepts, elucidating their respective contributions and implications across diverse research paradigms. Moreover, this paper underscores the importance of establishing clear definitions and boundaries for both the population and the target population. It emphasises how such precision is indispensable in guiding the formulation of effective sampling strategies, which are pivotal for ensuring the accuracy and reliability of study outcomes. Furthermore, it sheds light on how the clarity in defining these concepts significantly impacts the generalizability of research findings, elucidating how findings derived from a well-defined target population can be more confidently extrapolated to broader populations. In addition to methodological considerations, this paper investigates the ethical dimensions inherent in delineating population and target population. It underscores the moral imperative of accurately representing the groups under study, particularly ensuring equitable access to research participation and safeguarding against potential biases.
Background: Vision impairment (VI) affects people worldwide, and demographic factors like age are... more Background: Vision impairment (VI) affects people worldwide, and demographic factors like age are significantly linked to VI. Routine eye exams and other eye care treatments can detect and prevent common eye illnesses. However, many lack access to these services. Aim: This study’s major objective was to analyse the distribution and funding of eye care services by medical schemes in South Africa.
Setting: The study was conducted in the private sector in South Africa for benefits paid by medical schemes to optometrists, ophthalmologists and orthoptists.
Methods: A retrospective, longitudinal study of eye care services claim data from the Council for Medical Schemes (CMS) annual reports. The review period was 2020, and scheme-level data were gathered and analysed at the aggregated rather than benefit option level.
Results: In 2020, eye care benefits comprised 3.1% of total benefits paid; this proportion remained at the same levels throughout the review period. Closed schemes spent more per beneficiary per year than open schemes for optometrists, orthoptists and ophthalmologists. Self-administered schemes had 11% copayment for ophthalmology services, whereas outsourced schemes had less than 10%.
Conclusion: Optometrists had higher copayments than ophthalmologists and orthoptists. Medical schemes with capitated models had a lower average expenditure than other types of models, and the operating model affected expenditure; self-administered schemes spent less on optometry benefits when adjusted for beneficiaries. The study suggests reviewing eye care benefit funding models (risk vs savings), administration activities and managed care models for cost savings and health quality.
Contribution: This research contributes to the discussion and implementation of universal health insurance coverage through national health insurance in South Africa. The research shows that there are not enough eye care services in the public sector and that there are different funding gaps in the private sector.
Strategizing effective marketing initiatives while considering their cost-related factors require... more Strategizing effective marketing initiatives while considering their cost-related factors requires a targeted approach aimed at specific markets. The alignment of strategies with the intended markets is crucial to achieve desired outcomes. Research consistently emphasizes that successful marketing strategies should revolve around offering customers quality products at an affordable price point. However, the realm of medical schemes reveals a gap in comprehensively reporting marketing expenditure. Specifically, important attributes such as advertising expenditures and customer acquisition activities are not explicitly delineated, impeding a clear assessment of their value proposition for customers. The absence of comprehensive regulatory frameworks allows healthcare organizations to employ various marketing tactics, encompassing traditional advertising, direct marketing, digital marketing, and ad hoc marketing drives up marketing expenditure. Ad hoc marketing expenditure is notably prevalent in medical schemes, and a discernible trend of escalating expenditures in this category is evident. While this flexibility can be advantageous for organizations seeking to engage patients and expand their reach, it also opens the door to potential excesses and ethical concerns. Without adequate regulation, there is limited assurance that marketing activities align with ethical standards, respect patient autonomy, and prioritize responsible resource allocation. Moreover, the reporting limitations in the healthcare industry pose a formidable challenge. Healthcare marketing initiatives often involve nuanced and long-term objectives, such as building trust, enhancing patient education, and improving overall health outcomes. Measuring the direct impact of marketing expenditures on these multifaceted goals can be elusive, as traditional metrics may not capture the full spectrum of outcomes. This measurement gap hinders the ability to draw precise conclusions about the return on investment (ROI) of marketing efforts and their direct influence on membership growth. This research review aims to delve into the dynamics of marketing expenditures within medical schemes. The research objectives guide the analysis process, aiming to identify key factors driving marketing expenditures, understand variations in marketing strategies among different types of schemes, analyse the impact of marketing expenditures on growth and sustainability, and provide recommendations for optimal resource allocation. This study provides valuable insights into the challenges and implications of targeted marketing initiatives within the healthcare sector, particularly for medical schemes in South Africa.
This study delves into the complex challenges faced by health insurance providers, particularly w... more This study delves into the complex challenges faced by health insurance providers, particularly within the medical schemes sector, as they strive to develop effective marketing strategies. Emphasising the pivotal roles of customer engagement, service quality, and marketing in shaping patient experiences and organisational success, the research underscores the intricate interplay between patient engagement, quality customer service, and strategic marketing within the healthcare sector. Key components for success are identified, including actively involved patients, positive interactions with healthcare staff, and a holistic approach that integrates customer engagement, service quality, and strategic marketing. The study acknowledges the growing influence of digital channels in healthcare customer engagement while addressing challenges such as regulatory constraints, the unique nature of healthcare as a public good, and the lack of standardised metrics for assessing marketing impact. The research extends its focus to the health insurance sector, particularly medical schemes, highlighting the distinctive features of health insurance products. It emphasises patient engagement, complex sales processes, and coordination among multiple service providers. Social solidarity, community rating, and open enrolment principles are crucial in health insurance frameworks. The study further explores challenges medical scheme members face, emphasising issues arising from inadequate customer engagement, lack of information accessibility, and complex administrative processes. The study concludes with an analysis of marketing expenditure trends within the medical schemes sector, identifying cases where ad-hoc strategies significantly impact budgets and organisational strategies. It calls for regulatory bodies and industry stakeholders to establish clearer guidelines and caps on ad-hoc marketing expenditures to mitigate potential financial risks. The research aims to contribute valuable insights for policymakers, healthcare providers, insurers, and marketers to enhance marketing strategies and improve healthcare outcomes.
In the intricate landscape of healthcare governance, Annual General Meetings (AGMs) for Medical S... more In the intricate landscape of healthcare governance, Annual General Meetings (AGMs) for Medical Schemes play a fundamental role as a vital platform for transparent communication between administrators and members. Beyond formality, these meetings serve as a nexus for sharing critical updates, financial reports, and strategic plans. AGMs are crucial in guaranteeing transparency and accountability within medical schemes, actively involving members in the oversight of the healthcare community. However, the persistent challenge of limited member participation necessitates a closer examination of contributing factors and strategic measures for improvement. Key statistics on AGM-related expenditures in 2022 reveal insights into the financial landscape of medical schemes. Out of 71 schemes, 33 incurred AGM-related expenses totalling R29,2 million, covering 8.1 million lives. Challenges associated with AGMs include limited member awareness, accessibility barriers, and perceived irrelevance, prompting the need for strategic approaches. The paper suggests various strategies aimed at optimizing technology for enhanced communication, technological efficiency, the introduction of incentives, educational campaigns, and the promotion of a sense of community. Additionally, the paper presents a framework, influenced by insights from the COVID-19 era, with the goal of reinforcing the foundations of medical scheme governance. This framework aims to foster collaboration between administrators and members, contributing to the establishment of a resilient and responsive healthcare ecosystem. Overall, the study adds to the comprehension of AGM-related dynamics in medical schemes, offering practical recommendations and frameworks that can serve as guides for both scholarly research and practical implementations in the realm of healthcare governance.
This comprehensive review article thoroughly investigates the pivotal topic of healthcare service... more This comprehensive review article thoroughly investigates the pivotal topic of healthcare services' sufficiency for infants, encompassing prenatal care, neonatal care, vaccinations, and overall infant healthcare. With a focus on access, quality, and persisting challenges, the article underscores the critical need for infants to receive top-tier healthcare for optimal development and well-being. This research seeks to address critical gaps in infant healthcare through comprehensive investigations into prenatal and neonatal care efficacy, access disparities, and the impact of vaccinations. The objectives of this research review study were the assessment of the effectiveness of prenatal care, the identification and resolution of access disparities, the examination of the quality of newborn care, and the comprehension of the significance of immunizations. The significance lies in contributing to maternal and fetal health knowledge, advocating for equitable policies, and enhancing newborn health. The methodology involves a literature review, quantitative data collection for various secondary data, statistical analysis, case studies, and policy evaluations for a nuanced understanding of infant healthcare dynamics. The analysis underscores the need for a holistic perspective beyond single antenatal care (ANC) visits, revealing lower coverage of women receiving at least four ANC visits, especially in African countries. Despite the World Health Organization's recommendation to increase ANC contacts to a minimum of eight, global data reporting still centres on a minimum of four visits, signalling a potential delay in adopting updated guidelines and stressing the need for a more thorough and contemporary approach to antenatal care. In South Africa, significant variation among provinces is noted in vaccine expenditure per population under one year. Recommendations include conducting budget and financial expenditure analyses, ring-fencing vaccine budgets, and promoting broader health service utilization to address prenatal and neonatal care challenges comprehensively.
Strategizing effective marketing initiatives while considering their cost-related factors require... more Strategizing effective marketing initiatives while considering their cost-related factors requires a targeted approach aimed at specific markets. The alignment of strategies with the intended markets is crucial to achieve desired outcomes. Research consistently emphasizes that successful marketing strategies should revolve around offering customers quality products at an affordable price point. However, the realm of medical schemes reveals a gap in comprehensively reporting marketing expenditure. Specifically, important attributes such as advertising expenditures and customer acquisition activities are not explicitly delineated, impeding a clear assessment of their value proposition for customers. The absence of comprehensive regulatory frameworks allows healthcare organizations to employ various marketing tactics, encompassing traditional advertising, direct marketing, digital marketing, and ad hoc marketing drives up marketing expenditure. Ad hoc marketing expenditure is notably prevalent in medical schemes, and a discernible trend of escalating expenditures in this category is evident. While this flexibility can be advantageous for organizations seeking to engage patients and expand their reach, it also opens the door to potential excesses and ethical concerns. Without adequate regulation, there is limited assurance that marketing activities align with ethical standards, respect patient autonomy, and prioritize responsible resource allocation. Moreover, the reporting limitations in the healthcare industry pose a formidable challenge. Healthcare marketing initiatives often involve nuanced and long-term objectives, such as building trust, enhancing patient education, and improving overall health outcomes. Measuring the direct impact of marketing expenditures on these multifaceted goals can be elusive, as traditional metrics may not capture the full spectrum of outcomes. This measurement gap hinders the ability to draw precise conclusions about the return on investment (ROI) of marketing efforts and their direct influence on membership growth. This research review aims to delve into the dynamics of marketing expenditures within medical schemes. The research objectives guide the analysis process, aiming to identify key factors driving marketing expenditures, understand variations in marketing strategies among different types of schemes, analyse the impact of marketing expenditures on growth and sustainability, and provide recommendations for optimal resource allocation. This study provides valuable insights into the challenges and implications of targeted marketing initiatives within the healthcare sector, particularly for medical schemes in South Africa.
This study delves into the complex challenges faced by health insurance providers, particularly w... more This study delves into the complex challenges faced by health insurance providers, particularly within the medical schemes sector, as they strive to develop effective marketing strategies. Emphasizing the pivotal roles of customer engagement, service quality, and marketing in shaping patient experiences and organizational success, the research underscores the intricate interplay between patient engagement, quality customer service, and strategic marketing within the healthcare sector. Key components for success are identified, including actively involved patients, positive interactions with healthcare staff, and a holistic approach that integrates customer engagement, service quality, and strategic marketing. The study acknowledges the growing influence of digital channels in healthcare customer engagement while addressing challenges such as regulatory constraints, the unique nature of healthcare as a public good, and the lack of standardized metrics for assessing marketing impact. The research extends its focus to the health insurance sector, particularly medical schemes, highlighting the distinctive features of health insurance products. It emphasizes patient engagement, complex sales processes, and coordination among multiple service providers. Social solidarity, community rating, and open enrolment principles are underscored as crucial in health insurance frameworks. The study further explores challenges faced by medical scheme members, emphasizing issues arising from inadequate customer engagement, lack of information accessibility, and complex administrative processes. The study concludes with an analysis of marketing expenditure trends within the medical schemes sector, identifying cases where ad-hoc strategies significantly impact budgets and organizational strategies. It calls for regulatory bodies and industry stakeholders to establish clearer guidelines and caps on ad-hoc marketing expenditures to mitigate potential financial risks. The research aims to contribute valuable insights for policymakers, healthcare providers, insurers, and marketers to enhance marketing strategies and improve healthcare outcomes.
Uploads
Papers by Michael Willie
services by medical schemes in South Africa.
Setting: The study was conducted in the private sector in South Africa for benefits paid by medical schemes to optometrists, ophthalmologists and orthoptists.
Methods: A retrospective, longitudinal study of eye care services claim data from the Council for Medical Schemes (CMS) annual reports. The review period was 2020, and scheme-level data were gathered and analysed at the aggregated rather than benefit option level.
Results: In 2020, eye care benefits comprised 3.1% of total benefits paid; this proportion remained at the same levels throughout the review period. Closed schemes spent more per beneficiary per year than open schemes for optometrists, orthoptists and ophthalmologists. Self-administered schemes had 11% copayment for ophthalmology services, whereas
outsourced schemes had less than 10%.
Conclusion: Optometrists had higher copayments than ophthalmologists and orthoptists. Medical schemes with capitated models had a lower average expenditure than other types of models, and the operating model affected expenditure; self-administered schemes spent less on optometry benefits when adjusted for beneficiaries. The study suggests reviewing eye care benefit funding models (risk vs savings), administration activities and managed care models for cost savings and health quality.
Contribution: This research contributes to the discussion and implementation of universal health insurance coverage through national health insurance in South Africa. The research shows that there are not enough eye care services in the public sector and that there are different funding gaps in the private sector.
services by medical schemes in South Africa.
Setting: The study was conducted in the private sector in South Africa for benefits paid by medical schemes to optometrists, ophthalmologists and orthoptists.
Methods: A retrospective, longitudinal study of eye care services claim data from the Council for Medical Schemes (CMS) annual reports. The review period was 2020, and scheme-level data were gathered and analysed at the aggregated rather than benefit option level.
Results: In 2020, eye care benefits comprised 3.1% of total benefits paid; this proportion remained at the same levels throughout the review period. Closed schemes spent more per beneficiary per year than open schemes for optometrists, orthoptists and ophthalmologists. Self-administered schemes had 11% copayment for ophthalmology services, whereas
outsourced schemes had less than 10%.
Conclusion: Optometrists had higher copayments than ophthalmologists and orthoptists. Medical schemes with capitated models had a lower average expenditure than other types of models, and the operating model affected expenditure; self-administered schemes spent less on optometry benefits when adjusted for beneficiaries. The study suggests reviewing eye care benefit funding models (risk vs savings), administration activities and managed care models for cost savings and health quality.
Contribution: This research contributes to the discussion and implementation of universal health insurance coverage through national health insurance in South Africa. The research shows that there are not enough eye care services in the public sector and that there are different funding gaps in the private sector.