{"id":879224,"date":"2026-10-13T09:04:48","date_gmt":"2026-10-13T07:04:48","guid":{"rendered":"https:\/\/businesstech.co.za\/news\/?p=879224"},"modified":"2026-10-13T09:07:16","modified_gmt":"2026-10-13T07:07:16","slug":"why-medical-aids-need-to-be-active-partners-in-managing-chronic-conditions","status":"publish","type":"post","link":"https:\/\/businesstech.co.za\/news\/industry-news\/879224\/why-medical-aids-need-to-be-active-partners-in-managing-chronic-conditions\/","title":{"rendered":"Why Medical Aids Need To Be Active Partners In Managing Chronic Conditions"},"content":{"rendered":"\n<p><em>By Dr Wayne Riback, Chief Medical Officer, Medshield Medical Scheme<\/em><\/p>\n\n\n\n<p>For decades, public perception of healthcare funding has centred on a safety net for the unexpected, covering an emergency appendix removal, a sudden broken bone, or a bout of acute pneumonia. These are self-limiting health events with a clear beginning, middle and financial end. However, over the past fifteen to twenty years, a silent but aggressive shift has fundamentally rewritten this script. Today, the primary pressure on healthcare funding does not stem from sudden emergencies but from continuous, compounding chronic illnesses.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.medshield.co.za\/?utm_source=businesstech&amp;utm_medium=banner&amp;utm_campaign=medshield_campaign\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Click here for more info about Medshield Medical Scheme<\/strong><\/a><\/li>\n<\/ul>\n\n\n\n<p>Conditions such as diabetes, cardiovascular disease and hypertension require lifelong funding for daily medication, regular medical professional visits, ongoing diagnostic monitoring and, in some cases, repeated hospital interventions.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Navigating the chronic burden<\/h2>\n\n\n\n<p>According to Stats SA, recorded deaths from major chronic non-communicable conditions increased by 58.7% over a two-decade period. This is not just a clinical issue; it is a macroeconomic shift. Broad industry data indicate that roughly 33% of medical scheme members now live with at least one chronic disease. Even more sobering is that four major conditions, cardiovascular disease, diabetes, cancer and mental health issues, account for 84% of chronic care costs.<\/p>\n\n\n\n<p>The fundamental principle of medical aid is cross-subsidisation. A large pool of members who make relatively few claims helps to subsidise the significant and ongoing healthcare costs of those who are older, sicker, or living with chronic conditions. It is a delicate balancing act. As chronic illness becomes more prevalent, the pressure on that balance increases.<\/p>\n\n\n\n<p>Schemes must find ways to manage rising costs without simply passing them on to members through higher premiums, restricted benefits or increased co-payments. The consequences are already being felt. According to the Council for Medical Schemes (CMS), shortfalls, co-payments and other gaps contribute to more than R43 billion in annual out-of-pocket healthcare spending among South African medical scheme members.<\/p>\n\n\n\n<p>This is why the traditional role of a medical scheme as a simple claims payer is no longer sufficient. Because chronic conditions are lifelong, their management cannot begin only when a member is admitted to hospital. It needs to start much earlier, with prevention, early intervention, consistent treatment and coordinated care. This requires medical schemes to become active partners in managing health while ensuring the sustainability of the risk pool.<\/p>\n\n\n\n<p>The task is to expand access to appropriate treatment while safeguarding the long-term sustainability on which all members depend. This requires collaboration among medical schemes, managed care organisations, healthcare providers and other stakeholders, underpinned by robust clinical governance and evidence-based decision-making.<\/p>\n\n\n\n<p>Diabetes, hypertension and cardiovascular disease require sustained rather than episodic management. A model in which members engage with healthcare only when something goes wrong is neither clinically ideal nor financially sustainable. The Integrated Chronic Care Programme and Network provides prevention, monitoring, early intervention and ongoing support at a primary care level, ultimately resulting in improved outcomes as relates to management of chronic disease both for individuals as well as overall population health.<\/p>\n\n\n\n<p>Partnerships across primary care, specialist services, disease management and digital health can integrate these elements. The objective is not simply to manage claims more efficiently, but to help members manage their health more effectively and stay healthier for longer.<\/p>\n\n\n\n<p>Medshield\u2019s approach to chronic care illustrates this shift. Its chronic medicine management framework supports consistent access to approved medicines while using formularies and pharmacy networks to manage costs. Designated Service Providers help members access agreed networks and reduce the risk of unexpected costs, while specialised care networks connect members with coordinated pathways for complex conditions, including cancer care via networks such as ICON.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Smarter Healthcare Management<\/h2>\n\n\n\n<p>The underlying principle is that cost management should not simply mean giving members less care. It should mean finding smarter ways to deliver the right care at the right time and through the right channels.<\/p>\n\n\n\n<p>That distinction matters. A member who consistently manages a chronic condition is not only healthier; they may also be less likely to experience costly complications from unmanaged disease. For a medical scheme, therefore, investing in effective chronic care is an investment in both the individual member and the sustainability of the collective risk pool.<\/p>\n\n\n\n<p>As the rising prevalence of chronic disease becomes an undeniable reality, the medical schemes that will matter most will not simply be those that process claims efficiently. They will be those that understand that sustainable healthcare is ultimately about managing members&#8217; health, not just the cost of treating their illnesses.<\/p>\n\n\n\n<p>The future of medical aid is therefore not just about paying for care. It is about partnering to deliver care, proactively, intelligently and sustainably.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>For decades, public perception of healthcare funding has centred on a safety net for the unexpected, covering an emergency appendix removal, a sudden broken bone, or a bout of acute pneumonia.<\/p>\n","protected":false},"author":57,"featured_media":879228,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_sma_x_autopost_status":"posted","_sma_x_autopost_error":"","_sma_x_post_id":"2109903223616160074","_sma_facebook_post_id":"191437357620492_2235556653931400","_sma_instagram_post_id":"","_sma_x_attempts":1,"footnotes":""},"categories":[10459],"tags":[26786,17595,17357],"class_list":["post-879224","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-industry-news","tag-chronic-conditions","tag-medshield","tag-medshield-medical-scheme"],"_links":{"self":[{"href":"https:\/\/businesstech.co.za\/news\/wp-json\/wp\/v2\/posts\/879224","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/businesstech.co.za\/news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/businesstech.co.za\/news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/businesstech.co.za\/news\/wp-json\/wp\/v2\/users\/57"}],"replies":[{"embeddable":true,"href":"https:\/\/businesstech.co.za\/news\/wp-json\/wp\/v2\/comments?post=879224"}],"version-history":[{"count":4,"href":"https:\/\/businesstech.co.za\/news\/wp-json\/wp\/v2\/posts\/879224\/revisions"}],"predecessor-version":[{"id":879523,"href":"https:\/\/businesstech.co.za\/news\/wp-json\/wp\/v2\/posts\/879224\/revisions\/879523"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/businesstech.co.za\/news\/wp-json\/wp\/v2\/media\/879228"}],"wp:attachment":[{"href":"https:\/\/businesstech.co.za\/news\/wp-json\/wp\/v2\/media?parent=879224"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/businesstech.co.za\/news\/wp-json\/wp\/v2\/categories?post=879224"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/businesstech.co.za\/news\/wp-json\/wp\/v2\/tags?post=879224"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}