The country’s largest private medical aid, Botswana Medical Aid Society (Bomaid) showed strong growth in 2017 following structural changes. The medical aid fund has also warned of fraudulent claims and incidences of benefit overuse that have the potential to cripple the medical aid sector.
According to the medical aid society’s recently released 2017 annual report, the benefits of restructuring continue to yield positive results with group surplus at P13.9 million, roughly up three times the previous figure. The scheme surplus also showed positive momentum, profit was up from P1.1 million to P11.3 million. This was Bomaid’s second successive year of surplus.
The good performance was largely the result of the organisational structure which was rationalised with a number of new management appointments being made during 2017, as the society positioned Bomaid for the implementation of the 2017-2021 strategic plan and consolidation of the revised structure. Under the revised structure, the loss making condom manufacturing subsidiary, Alpha Access, was shut down, while fund administration was moved back in house to Bomaid from Southview, which is now an investment holding vehicle for MRI, another subsidiary of the medical aid society.
Moraki Mokgosana, the fund’s Principal Officer, notes in the annual report that the previous year has not been without its challenges, citing high levels of unemployment and dwindling levels of disposable income which continue to hamper the prospects for growth in the membership of the fund.
“Although the Fund has minimal exposure in the mining sector, Bomaid has been affected to the extent of loss of jobs for the support industries in the affected mining areas and reduced economic activity,” he said.
Despite the challenging economic conditions and increased unemployment, net principal membership continued to grow, albeit at a subdued pace, from 38 596 members in 2016 to 39 796 in 2017. Bomaid covered a total of 86 147 lives, up 2.3 percent from 84 197 the year before.
“As a consequence of increased unemployment, the overall medical aid market has contracted, with one medical aid being forced into curatorship. However, the net increase in our membership numbers reflects an increase of Bomaid’s share of the open scheme market, which grew by 2 percent to 54 percent,” he said.
Mokgosana who has in the past spoken strongly about fraud in the medical aid sector says risk management has become more topical in the wake of rising cases of fraud, wastage and abuse.
“It is estimated that the impact of this on medical aids is between 7 percent and 15 percent of the healthcare costs. It is, therefore, imperative that the industry stand in unison to fight this risk.”
At the society’s 47th Annual General Meeting held end of last month, Bomaid members voted in favour of revising and modernising its book of rules ÔÇô the current version dates back to 2012 – in order to keep up with new developments in the medical landscape, such as diseases not previously covered or new interventions and treatment options.
“We need to ensure that the cover we offer remains relevant to the real health issues facing our members, particularly with regard to chronic disease management and HIV and AIDS. Other changes include the addition of some organ transplants not previously covered, as well as a revision of the definition of child dependents, which has been increased from 21 to 25 years,” said Mokgosana.