The challenges facing privately funded healthcare decision makers
However healthcare cover is provided – through commercial, industrial, an in-house scheme or an in-house clinic or hospital – the challenges within the South African healthcare environment are universal…this is the management of risk. Risk presents itself in many forms. The risk of uncontrollable rising contributions, rising costs of healthcare delivery, contractual post-retirement obligations, disease management (e.g. AIDS), to name but a few.
Factored into this is the vast complexity of managing risk with regards to:
- Administration
- Benefit design
- Delivery model design
- Provider negotiations and management
- Re-insurance
- Legal matters (rules, agreements, statutory compliance)
- Managing of third party contractors
- Member education and communication
- Financial management
- Clinical risk management
- Hospital Utilisation Management
- Pharmacy Benefit Management
- Disease Management
- Management of in-house clinics or hospitals
- Management of wellness / wellbeing healthcare services provided by employers
All of these require a high level of specialised intellectual capital in many different disciplines, including financial, legal, actuarial, clinical, IT, communications and administration.
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