The Qualities Of A Reputable Healthcare Advisor

Well, welcome to another episode of the MedXpert podcast brought to you by Optivest Health Services. I’m your host Lincoln. Today we’re going to delve into an essential topic for healthcare consumers in South Africa: How to find the right healthcare advisor for your medical scheme and related products. Managing medical costs is crucial and a good relationship with a knowledgeable and skilled healthcare advisor can make all the difference. Now, today we have an expert guest who is with us who will shed some light on what makes a trustworthy and proficient healthcare advisor and the duties they are required to perform.

Werner Coetzer is an expert in the medical scheme industry and has extensive knowledge about the healthcare industry. Werner Coetzer from MedQuote, an organisation that offers consumers easy and accessible medical scheme quotations and comparisons for medical scheme members or those wanting to join a medical scheme. Now, thank you for joining us today, Werner.

Thanks for having me, Lincoln. Thanks, I appreciate it.

Werner, I think it’s no secret that that most consumers are under a lot of financial strain. If you look at the macro-economic market in South Africa and globally, how financially the sectors are already taking strain. Why is it important that consumers really find a good healthcare advisor? So, to start off, could you tell our listeners what are the key attributes that make a good healthcare advisor for medical schemes in South Africa?

It’s a loaded question, Lincoln, but let’s get to the bottom of it. I think a strong understanding of the following is very important: the South African healthcare model versus the rest of the world, and then a strong understanding of the fundamentals of private cover in South Africa. Brokers have to have the ability to go through a maze of information, 72 medical schemes, and more than 230 benefit options. It’s a lot of information to go through and whilst going through all of that, they’ve got to have an intricate understanding of this legislation that regulates this industry as well. Examples of this are open enrolment, community rating, and waiting periods. It makes it very complex and the most important aspect for the broker is the consumer education, empowering clients to understand their entitlement to benefit and the articulation of that to simplify it for the client that’s very important. The brokers should be able to accommodate that quite easily.
It’s crucial to understand what qualities and expertise to look for when selecting a health advisor, as they play a significant role in guiding consumers through the complexities of medical schemes.
Then, coming to the next question, what duties are healthcare advisors required to perform to ensure comprehensive coverage for consumers?

I think adherence to the regulatory and legislative requirements is important. They must accredit the Council of Medical Schemes, they must be licensed the FECA and the Financial Services Conduct Authority, and they’ve got to acquire a Wealth Management diploma. All the regulatory exams need to be done, they’ve got to clock 120 hours of CPD points, and through all of that, it’s important for them to still have a very strong understanding of every consumer’s different needs. So, you must go through a very strong needs analysis with the client because every single consumer is different. In doing so, it’s important that they specialise in that. It’s very important that they can go through that and have a very strong knowledge base. That is essential.

It would be good for a broker to have a strong retention unit that can assist clients when the claims start coming in. But the most important duty is to act in the client’s best interest. They need to have the ability to listen, then make or propose a solution, and implement it.

In layman’s terms, what happens is many advisors are out there placing you on a medical scheme. But like you mentioned, the backup service of having a retention unit, a servicing unit, essentially being able to assist the client once they put them onto a medical scheme that really is lacking in the industry. And like you say, being able to decipher that jargon and assist the client when they are in need, I think that’s very important.

Now, Werner, how do healthcare brokers use technology to simplify the information for consumers?

I think it’s very important for brokers to have access to electronic comparative information. It’s very important because all schemes use their own jargon. They’ve got all their own marketing collateral that they use, and consumers find it difficult to understand it. So, for a broker to use a comparative platform, it will greatly assist them when they go into a consultation with the client. Many brokers do have member portals where there’s information available.

The quality of that information varies from broker to broker, and that’s important to test the broker’s ability to educate clients. From a technological point of point of view, certain brokers have got stronger relationships with schemes where they have strong, direct access to the administrators’ portal. I think it’s quite important, but I also think the guidance of a healthcare broker remains invaluable in deciphering the complex details and providing impartial overviews.

Now, our listeners should be aware of the importance of working with a registered healthcare advisor. Can you explain why it is vital for health care advisors to be registered members of the council for medical schemes. And the second part, do you believe that a healthcare advisor can add value in assisting a consumer with finding and selecting the best health cover solution?

Apart from being a legislated requirement, adherence to the provisions of the council is intended to protect consumers. So that’s very important to understand, consumers should also be aware that brokers acting on their behalf are indeed accredited accordingly and licensed accordingly. That’s very important and that’s primary. It’s important for consumers to test the ability of the broker to render dedicated support services, post-sale implementation.

Do the brokers have certain sufficient resourcing available after post sale, do they have the direct access to the administrative platforms? Do they have a strong knowledge base? How will complex claim queries be dealt through that retention unit?

These are very important aspects that consumers need to test if the broker can deliver on that. Just to mention the fact that last year, I had contacted my broker when I found that my wife was about to deliver, and we had booked the bed. But I didn’t know that with my gap cover I could have the benefit of a private award. In that conversation with the broker, I then found out I was able to experience it with my wife, a more intimate experience with that delivery of the birth. And then slightly thereafter, I had a little accident at home.

I never knew I had a casualty benefit as well that paid out. So, I guess in that value, I will be able to retain a lot of value from your broker because we don’t necessarily, when I say we, the consumer, doesn’t have the knowledge to decipher and understand how these products always work. If a broker can explain that to you in more detail, I guess then they add in real value to you. Education is key in this instance.

I think too many times I see that consumers have products in place that they don’t understand. They do not know exactly what they have and do not understand the entitlement to benefit. They do not understand the entitlement to the chronic cover. There’s a whole lot of things that the consumer doesn’t necessarily understand that the broker should have made sure that the client is aware of his entitlement benefit. Consumer education is significantly important.

I completely agree. Now, we may have touched on this, but the reputation is undoubtedly an essential factor when choosing a healthcare advisor. Can you share some insights on how consumers can verify the reputation of a healthcare advisor before making this important decision, as mentioned before.

Consumers should as a minimum, ensure their brokers are credited with the council simply by visiting their website to check their accreditation status and then visiting the FECA website to confirm their licensing status, for Category 116 health benefits.

Furthermore, I would propose that consumers visit the broker’s website, essentially the online voice of the broker and the consumer will get a feel by visiting the website. The longer the broker has been around, there should be more consistency in the deliverance of that. And again, we’ve mentioned it, but broker size is important. It creates economies of scale. So, you’ve mentioned one or two things that you’ve gone through lately. Economies of scale will create better outcomes for consumers and build that trust factor too.

Is there anything else in today’s conversation that you feel we could possibly add? Just as a final word?

The most important thing again, Lincoln is education. Educating our consumers so they can understand the product they are buying. That’s the shortcoming in the industry now. I think the brokers have a very large role to play in this instance, and by using a broker, you would create the opportunity for the consumer to make more informed decisions and understanding what they’ve bought.

That’s that access to a broker will give. You should give you access to an annual review of the product that you’ve chosen and to make sure that it’s aligned for the for the upcoming year. So very important to use a knowledgeable and a strong broker. It creates a better outcome.
Now, benefit review season is coming up essentially where people can review their status and whether on the right option and look at what they possibly could be shortcomings. In considering the macro-economic market and the importance of a healthcare advisor, how important a role will they play in deciphering that if the cost factor is essentially for most of Africans at this stage? What role can a broker play when advising a client for the year? That is probably one of the biggest debates now carrying on post COVID, in the two years after COVID, the annual increases on medical schemes have been relatively low utilisation and didn’t spike the way that schemes thought it was going to.

We’ve seen two years of relatively low annual increases; all indications are there that industry has recovered and that utilisation has recovered. We will probably see annual increases, again normalising to pre COVID levels. That’s essentially increases 2 to 4% above inflation, starting to bring it back to the 10% that we were used to pre-COVID and that is a very problematic given the macro-economic conditions that we currently in. We are coming already from a high base from a contribution point of view.

It is so important for consumers, especially going into 2024, to make very strong decisions about the cover for the next year ensuring that they are not over insured and to make sure that they also not under insured. So, they just must have the right product set and make up, and that’s with regards to not just the medical aid but also the bridging finance products. The gap covers the health insurance cover or complementary products to make sure that they make a very good decision, the broker should assist greatly in that regard.

I know there’s been a lot of speculation recently about NHI and the role that it would play. But I think the more important question for private medical scheme members, what will be the role for private medical schemes in future in terms of the whole speculation and how they could co-exist in future? What do you see for the future for private medical schemes?

I think private medical schemes will be around for many years to come. It’s an essential part of our healthcare model in South Africa. It covers 9 million beneficiaries in South Africa and just by taking that away, it will have a probably, in my opinion, have a detrimental effect on our healthcare model.

I think universal access to health care is important. We all understand, not just the complexities, but the need for an NHI model. The way that it’s going to be implemented, it’s going to be tricky. But I do foresee that medical schemes will continue for many years to come. It’s an essential part of our funding model and it plays a large role in complementing our entire model and its very important role for the medical scheme moving forward.

I agree. I think, from what we’ve seen, there’s been a lot of hype and recent people panicking. I think you’ve reiterated the fact that, in terms of many years to come, that a private medical scheme plays a fundamental role in our funding system and health care funding system, Lincoln.
I think it’s important to mention especially, the South African medical scheme industry hinges very strongly on an aspect where we have cross subsidisation. Unfortunately, now with the NHI talks, the younger members are resisting joining the medical scheme industry.

It’s important for everyone to understand that first and foremost, the medical scheme grants significant access to very strong health care outcomes. In the context of South Africa, we have some of the best healthcare in the world which is funded through medical schemes. I always motivate youngsters just coming into formal employment to join medical schemes. I think it’s very important, it’s the cornerstone of our health care system. It’s going to play a large role moving forward into NHI. But for now, anyone coming into formal employment should strongly consider joining a medical scheme.

Yeah, I agree. I think it just sheds light on what you said in the article. I think they mentioned in 2021 the total contributions collected by medical schemes was R250 billion. So, you take that out the equation and that makes a huge hole in our health care sector. So, I think it’s very important.
Werner, anything else you’d like to say as a final word.

No, thank you very much for having me. It was great and I would strongly suggest listeners to educate themselves, go visit the information portals that are available, and make sure that they make informed decisions and then turn to a broker.

Well, thank you Werner for shedding light on the vital role of health care and in helping consumers navigate the complexities of the medical scheme industry in South Africa. Understanding the attributes of a good healthcare advisor and the duties they perform can undoubtedly empower our listeners to make more informed decisions about their healthcare coverage.

We trust you found this episode helpful in your healthcare journey. For more information, you’re welcome to check out our website at www.medxpert.co.za, where we have free resources available for download and other relevant details about selecting a reputable healthcare advisor.

Thank you for joining us on this episode of the MedXpert podcast. Your go to resource for unlocking the full potential of your medical scheme benefits to access additional resources and relevant articles.