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Policy, Research and Monitoring

Research reports and studies

The Research and Monitoring Unit serves beneficiaries of medical schemes and members of the public by collecting and analysing data to monitor, evaluate and report on trends in medical schemes and develop recommendations to improve the regulatory policy and practice.

Research conducted by the unit currently covers the areas of utilisation of health care services in the private sector, strengthening governance in medical schemes by proposing a framework for trustee remuneration and development of a process for measuring quality and outcomes in the private health care sector. Research methods include a combination of literature reviews, consultative processes, surveys, and statistical tools. Research output is often disseminated to the medical schemes industry through the publication of monographs and presentations at industry consultative forums.

This report examines disease management practices in South Africa’s private healthcare sector, focusing on adherence to minimum standard-of-care tests and procedures among Disease Management Program (DMP) beneficiaries. Data from 71 medical schemes covering 9 million beneficiaries were analysed, revealing significant growth in DMP enrolment for chronic conditions like hypertension, diabetes, HIV/AIDS, asthma, and COPD. However, disparities in coverage ratios across benefit options were observed, particularly in essential screenings for diabetes and hypertension. HIV/AIDS management showed robust access to antiretroviral therapy but highlighted disparities in viral load suppression, especially among male beneficiaries. Gender-specific differences in healthcare utilisation were noted, with females showing higher service utilisation. The report emphasises the importance of comprehensive disease management strategies to improve health outcomes and control costs, suggesting interventions like improved coordination of care, incentivising adherence to protocols, enhancing transparency, and implementing targeted education initiatives. Collaboration among healthcare stakeholders is vital to address disparities and improve disease management practices, ultimately optimising health outcomes and cost control in the private healthcare sector.

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Research Notes 2024

 

Research Notes feature the latest studies from the Council for Medical Schemes.

Research Note 2024

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Quality of Care in Medical Schemes

Quality of Care in Medical Schemes
Size: 1.45 MB
Date added: 07-05-2024
Date modified: 12-06-2024
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RESEARCH PROFILE: Audit Firms within the Medical Scheme Industry

RESEARCH PROFILE: Audit Firms within the Medical Scheme Industry
Size: 669.40 KB
Date added: 17-04-2024
Date modified: 10-05-2024
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The Value Proposition of DSPs in Medical Schemes: A Strategic Analysis

The Value Proposition of DSPs in Medical Schemes: A Strategic Analysis
Size: 699.48 KB
Date added: 15-02-2024
Date modified: 10-05-2024