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LOCAL MANAGEMENT AND COST CONTAINMENT OF MEDICAL TREATMENT IN SOUTHERN AFRICA. Interhealth Technologies (IHT) acts on behalf of ASSISTANCE COMPANIES, INTERNATIONAL HEALTH INSURANCE COMPANIES as well as INTERNATIONAL CORPORATES and GOVERNMENT AGENCIES, to manage the local & regional healthcare for their clients and employees We pride ourselves in the fact that we are independent medical claim managers in the Southern Africa healthcare industry. We are not linked to any particular hospital group or any other service provider network. We work on a very "hands on" approach with our patients, thereby ensuring that they receive personal service. The benefits of this independence are that we are able to negotiate special rates with the various hospital groups and all the other service providers in the healthcare delivery chain. These benefits are then passed on to the client. We are able to refer our members / patients to the most appropriate service provider - without limitations! The healthcare delivery network in South Africa is one of the more complex systems in the world. This complexity works in the favour of the service providers who benefit by having various tariffs for the same procedure. The private hospitals usually only provide the "hotel" component of service delivery chain - this is the accommodation (wards etc), nursing and surgical theatres. Most other services that are provided within a hospital are usually contracted out to specialist companies i.e. radiology, laboratory / pathology, doctors and specialists. All these service providers do their own billing for each patient in the hospital. They control the tariffs which they want to charge. Where the patient is regarded as a foreign patient, the tariff automatically is adjusted to a much higher tariff compared to a local patient, especially a locally insured patient. The tariff difference varies drastically dependant on type of service provider, from a minimal percentage up to as much as 200% in certain cases. The average is 30% to 50%. Where international healthcare funders are concerned, they are sometimes lured into entering agreements with hospital groups to manage the entire healthcare treatment procedure for their members. This decision has few advantages and many disadvantages. The advantages are that the patient should get immediate access to treatment and perhaps reasonable hospital tariffs. The disadvantages are that all the secondary service providers, who are not owned by the hospital group, are given "open cheque book" access to treat the patient, as the patient is in the hospital and they can charge their full private tariff for the services provided. It is not in the hospitals interest to interfere with these charges, as these service providers are "tenants" for the hospital group and are a source of patients (revenue!) for the hospital. The hospital would also prefer to have the member hospitalised for as long a period as possible. In many instances, where proper medical case management is provided, the patient could be hospitalised for a limited period and have their follow up treatment managed on an outpatient basis, thereby ensuring savings for the funders. The above process applies to both in and out patient treatments. At IHT, we manage the whole process on behalf of our clients, by managing the entire process, from the time the member has identified that they require medical treatment, through the treatment process right up to the final billing, ensuring that over-servicing and overcharging are limited. We provide a 24 hour - 365 day service for our clients. We are a local company with a regional network covering the whole of Sub Saharan Africa whereby we are able to evacuate patients from anywhere is this region to the most appropriate treatment location in South Africa. Apart from our services in Southern Africa, our service provider network covers the Middle East and India, where we have cost containment and case management systems in place in both regions. We manage the entire process on behalf of international funders, from an initial local contact point for their members, gathering information and getting the authorisation from the funders, to proceeding with the treatment, through the management of the treatment to the final checking and billing process. This system makes the entire process more convenient for members in the region, as well as a smoother and more cost efficient process for the funders. The final payments to all the individual service providers are processed through IHT and thereby the funders only make one payment and have one point of contact for the entire healthcare delivery for their members. We are able to reimburse service providers in various countries in the region, as well as reimburse members for payments made by the member, once we have received authority from the funders to reimburse the member. This process can accommodate co-payments that have to be made by member, whereby we deduct the co-payment amount from the actual amount paid back to the member. Our clients vary from Governments, Corporates, to large International Health Insurance Companies and Assistance Companies. Our philosophy is to keep the business model as simple as possible and reduce the burdens of our clients, whilst saving them money and ensuring that the medical treatment process is made as convenient as possible for their members. In line with our business model of keeping all processes simple, our charging system is just as simple. We charge a small margin on all final processed bills. This overall charge is less than the overall savings that are made by utilising ours services, thereby ensuring that our clients benefit in more ways than one. For further information please click here to contact us.
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