5. Health-care in SA

Question 1

Apart from the provision of medicines, … also provide important education and training to pharmacists and other distributors of medicines, such as hospital dispensaries.

Answer 1

drug manufacturers

Question 2

Due to the … most medical expenses will happen after retirement or about age 65.

Answer 2

uneven distribution of health care expenses

Question 3

Expenditure by an … on medical service for an employee in terms of a registered medical aid scheme, ranks as a deduction in terms of Section 11(l) of the Income Tax Act.

Answer 3

employer

Question 4

Growth on funds held by a medical aid scheme or a benefit fund other than a provident fund are not …

Answer 4

taxed

Question 5

In accordance with Section 18 of the Income Tax Act: Any … , who is a natural person, is allowed to deduct from his income expenses of a medical nature.

Answer 5

taxpayer (employee)

Question 6

It is common practice for schemes to offer members a …, varying from a low cover plan, where relatively strict limits are imposed in return for a lower membership fee, to a full comprehensive plan at a far higher contribution level.

Answer 6

choice of cover

Question 7

It is known that the South African healthcare system is prone to … In some cases, doctors or other suppliers, take advantage of the uninformed nature of their patients to over-prescribe treatment, or even to simply charge for services not rendered.

Answer 7

fraud and abuse

Question 8

Name four legal controls on health-care environment?

Answer 8

1. Legislative outline
2. Medical schemes Act
3. Taxation
4. Inspection of financial institutions act of the FSB

Question 9

State health involvement may seem advantageous but one needs to remember that this can only be funded out of … revenue and often is not the most efficient delivery system.

Answer 9

taxation

Question 10

The legal control of the … sets out to indicate what provisions will be made, what will be the scope of services provided, how financial reporting and prescribed minimum benefits will be covered by the Act.

Answer 10

Medical Schemes Act

Question 11

The legal control of … is about the power and the rights the Registrar of Medical Schemes has to lodge applications to court for the cancellation and suspension or dissolution of funds.

Answer 11

inspection of Financial Institutions Act of the FSB

Question 12

The legal control of … sets out only the broad parameters under which the various registered providers operate. The details and requirements are contained in regulations issued by the minister governing the more day to day controls.

Answer 12

legislative outline

Question 13

The legal control of … to medical services in South Africa is somewhat disjointed with the use of a benefit fund for medical benefits having been prevalent where the fund was in fact not a medical aid registered in terms of the Medical Schemes Act.

Answer 13

taxation

Question 14

The … insurance product pays out a fixed amount for every day or night spent in a hospital, often with double benefits if intensive care is required.

Answer 14

hospital plan

Question 15

The … on a medical savings account is currently not taxed, although mention has been made of a possible change to this in the future.

Answer 15

interest

Question 16

The … insurance product pays out cash sums for various types of major surgeries undergone, with the amount varying according to the perceived complexity, and hence cost, of the treatment.

Answer 16

major medical cover

Question 17

What are the six key issues facing the health-care system in South Africa:

Answer 17

1. changing level of state health involvement
2. uneven distribution of healthcare expenditure
3. cross-subsidization
4. insurance principles versus primary care
5. fraud and abuse
6. employers liability

Question 18

What are your six typical private health-care providers:

Answer 18

1. drug manufacturers
2. chemists
3. doctors
4. private hospital clinics
5. medical schemes
6. medical assist

Question 19

…, also known as pharmacists, supply medicines to the public, usually on the prescription of medical practitioners such as doctors or specialists.

Answer 19

Chemists

Question 20

… is usually when people of different, ages, gender, habits, etc balance each other out based on what they pay from a premium stand point.

Answer 20

Cross-subsidisation

Question 21

… is healthcare products where operators try to manage the cost side of the equation through a variety of different efforts.

Answer 21

Managed healthcare systems

Question 22

… is when companies provide emergency treatment and transportation services, using fleets of cars, small motorboats, helicopters and small aircraft’s to take trained paramedics to the site of an emergency, and to transfer the patient to the appropriate medical care centre.

Answer 22

Medical assist

Question 23

… are benefit funds, in that they take in monthly contributions from members and reimburse medical expenses according to set scales of benefits.

Answer 23

Medical Schemes

Question 24

… make use of a combination of their own support medical staff and private practitioners, who use their facilities to treat patients.

Answer 24

Private hospital clinics

Question 25

… is a healthcare product where the member pay contributions according to their salary band and size of the family covered. They are adjusted over time, to take into account the actual claims experience of the members.

Answer 25

Traditional medical schemes