Botswana Medical Aid (BOMAID) society will in the near future sign a Memorandum of Agreement with three specialist Hospitals in India as an alternative for its members to access specialist health care services. The signing of the agreement will be finalised by the end of May 2016.
In an interview with the Sunday Standard, on the sidelines of the stakeholder’s breakfast meeting which was held by BOMAID in Francistown last week, the Fund Administration Manager, Dr Ludo Mangadi revealed that they made decision after realising that most of their members preferred Indian health specialists for some of their health services.
“In the last three years, of all the foreign medical claims that we paid for, it emerged that apart from South Africa, most of our clients preferred India for specialist health services. We have evaluated their service in terms of quality of care and costs. Our team was recently in India and our research shows that generally costs of service in India are less as compared to our region. Their health care is also of high quality,” she said.
Although she could not give much detail about the agreement, she said in India there are a number of health specialists in areas of organ transplants. Dr Mangadi said that they want to give their members access to these specialised services more so that they are cheaper and of high quality.
She also revealed during her presentation that BOMAID members do not need any referral for them to use services across borders. She also said the coverage for medical expenses is on the same principle as that of procuring services locally. She further said that reimbursement of services obtained outside the country is at agreed rates in the case of major South African hospital groups and independent practitioners.
“However there are services that can be medically necessary but have not been considered for cover by the society. Members can still access the services but at their own costs. The problem is that, inclusion of these services may necessitate escalation of subscription across the entire membership as some services are very costly,” she explained.
She further said the other services that are not covered by the medical aid include among others, cosmetic plastic surgery, reconstructive surgery for cosmetic purposes, revision of scars and keloids, weight reducing procedures and artificial insemination. She said all expenses incurred by a member arising out of willful self-harm, social issues, attempted suicide, substance abuse or injury incurred in breach of law will not be covered.
“Expenses of injuries sustained from participating in professional sports such as soccer or rugby or any other dangerous sporting activities such as parachuting, bunjee jumping, sky diving, motor racing and others are not covered,” added Dr Mangadi.
Presenting on the strategy update of BOMAID, the Principal Officer, Moraki Mokgosana said the organization has reaffirmed its initial strategy of 2015 which is underpinned by separation of the society from its administration, establishment of (SouthView); a department which has taken over the administration function, driving and managing growth of the Commercial Investment Interest of BOMAID.
“BOMAID will continue on the path to growth of reserves to remain resilient against the onslaught from entrants, enhanced value proposition through innovativeness, improved quality of customer service and incorporation of health performance of the scheme as a measure of overall performance,” he said.
Among other important issues, Mokgosana said subscription from members has increased owing to the health care inflation that has continued to outpace the Consumer Price Index (CPI) in 2015. He said while statistics Botswana reported an annual CPI in October 2015 at 3.1 percent the healthcare inflation rate was at 6.6 percent.
“The claims experience has increased, outstripping the increase in members. The scheme has been running at a deficit for the past two years. In order to maintain financial stability and protect reserves, annual increases must be realigned. 2016 subscriptions ranged from seven percent to 14 percent,” he added.
