Sunday Times (Johannesburg) - November 14, 2004
David Ball

"NINETY and still going strong" is the message from Bankmed's top brass - and the leading healthcare giant in South Africa's banking sector is looking to the future with optimism.

Bankmed general manager Rod Gush says the scheme's annual turnover of R1.4-billion is backed by strong corporate governance and a low risk profile ensuring a good claims ratio.

The international rating agency Global Credit Ratings clearly agrees. It awarded Bankmed an AA- rating in July - one of the highest ratings given to any medical scheme in South Africa.

The strong rating demonstrates a very high claims-paying ability, based on Bankmed's strong solvency and liquidity ratios, among other factors.

Bankmed's member surplus of R503- million last year equates to a statutory funding ratio of 40%, which is well above the requirement of 22% for 2003, according to Global Credit Ratings.

The definition of AA- is: "Very high claims-paying ability. Protection factors are strong. Risk is modest, but may vary slightly over time due to economic and/or underwriting conditions."

As it celebrates its 90th anniversary this year, Bankmed has grown from 77 individual members when it started out, to 83000 members at 23 banks, including the Reserve Bank and the country's biggest retail banks.

Despite its overwhelming dominance in the banking sector, Gush says the scheme is committed to growing its membership base even further over the next five to seven years.

This is in response to the anticipated consolidation of the medical schemes market in South Africa, which will mean that size will matter in the future.

"There will undoubtedly be significant consolidation of medical schemes in the next five years."

Gush says more members will give the scheme extra bargaining clout when negotiating with administrators, hospitals and preferred healthcare providers.

Commenting on the proposed Barclays takeover of Absa, Gush says this is likely to have no major impact on the scheme. "It makes logical business sense for the new Absa/Barclays to stay with Bankmed."

One of the scheme's core strengths is its range of products, designed to suit employees across the salary spectrum.

Products range from an entry-level product costing just R520 a month to a high-end product costing R1 600 a month, aimed at the banks' senior executives.

Bankmed Core is aimed at families earning less than R5000 a month and provides extensive primary care, while Bankmed Plus pays full benefits and private ward fees with little or no co-payment by the member.

Bankmed's Comprehensive plan, however, is the most popular, with 90% of members subscribing to it. The plan provides comprehensive cover for in-hospital and out-of-hospital treatment at a cost of R1200 per month, including 25% savings.

Gush says it is crucial for medical schemes to provide the most appropriate and affordable healthcare in light of soaring medical costs in South Africa and internationally.

Bankmed's managed care programmes are run in partnership with Managed Healthcare Systems (MHS) and Qualsa and are aimed at getting the best clinical outcome for the member - and coupling this with the best financial outcome for the scheme, says Gush.

One of the key components of Bankmed's managed care programme is an integrated approach to disease management. Gush says diabetes, for instance, is a complicated disease affecting different parts of the body that may require benefits for a general practitioner, optician, cardiovascular specialist and nutrition expert.

"We don't just manage a single event; we manage the whole member."

He says the scheme's focus on client-centred, holistic healthcare is reaping rewards, with the number of members who felt "trapped" in the scheme dropping from 26% in 2001 to 15% last year, according to the scheme's annual member survey. This is seen as a significant achievement as medical aid is a grudge purchase for many people.

While Gush acknowledges the challenge of managing HIV/Aids, he says prevalence rates within the banking sector are low compared to industries such as mining or transport. A comprehensive prevalence survey across SA's largest four banking groups last year indicated a prevalence rate of 3.4%.

Gush says he is concerned, however, that only around 1% of its members are enrolled on the scheme's HIV/Aids programme, indicating that between 2% and 2.5% of the scheme's HIV-positive members are "uncontrolled".

He says just over 900 members are enrolled on the HIV/Aids programme, which provides voluntary counselling and testing, consultation, monitoring and antiretroviral treatment.

Overcoming fears about confidentiality and the social stigma surrounding HIV/Aids remains a major challenge.

On a human note, Gush says Bankmed's special grant payments, which amount to as much as R2-million a year, demonstrate the scheme's commitment to members. These ex gratia payments are made to members and families who are financially stressed as a result of excessive medical expenditure, such as a schoolboy paralysed in a rugby accident or a pensioner suffering from a rare blood disease.

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