Professionals: Healthcare » Press Room

Media release: 'Get professional advice when choosing medical schemes for your staff' Ian Dodds of Fundamental Investments ‘To understand the inner workings of a medical scheme these days you almost need a PhD,’ says veteran financial advisor Ian Dodds. ‘Employers need a guide who has a comprehensive understanding of a range of medical scheme products,’ says Dodds, who has been an independent financial advisor for over 32 years. ‘In the first place, an advisor should take time to ensure that he or she understands the needs of the company’s employees. People of different ages within a company have significantly different needs and those with chronic illnesses need special advice. Sometimes this calls for making more than one open medical scheme available to employees,’ he says. ‘The geographic location of the employees and their dependants is a key factor,’ he says. ‘For example, different medical schemes reimburse members at different rates. Some premiums are either based on the 100% cover at the National Health Reference Price List (NHRPL) rate level, while others pay at 300%, which is in line with the old ‘contracted out’ or SAMA rates,’ he says. ‘While you obviously find some exceptions to the rule, doctors and specialists in the major urban areas tend to charge their time at higher rates, so people living in urban areas may well choose to join a medical scheme with higher cover. On the other hand, if the employees of a company live in smaller towns, it is more likely that a scheme that pays at the NHRPL rates will be cost effective,’ he says. The location of hospitals that belong to different hospital groups is also critical to the members of capitated schemes. ‘Capitated schemes are a fairly recent feature of the medical scheme industry,’ explained Dodds. The growth of these schemes has essentially been in anticipation of the compulsory provision of medical cover for employees. Capitated schemes provide for unlimited doctor visits, basic dental care, screening and hospital care. However, on the downside, members of capitated schemes are limited in their choices of medical services,’ he says. ‘For example, some managed care companies are geared to the blue collar market and provide their facilities in industrial and semi-industrial areas. This may mean that office workers who were members of one of these networks may have to travel out of their way to receive medical attention. On a larger scale, it might be possible that an employee’s dependants would only be able to access medical care at a hospital several hundred kilometers from home,’ he said.