#3  Improving Healthcare Coverage: BHF's Tool for Medical Schemes | BHF Conference 2023 | Episode 3

In this conversation, Lubaletu Dube, an actuary consultant at Insight, is joined by Dr. Rajesh Patel from BHF (Board of Healthcare Funders). They discuss a tool developed by BHF that measures the coverage provided by medical schemes and their ability to meet the needs of their members. Dr. Patel explains that the tool supports the strategic positioning of universal healthcare coverage and helps schemes identify gaps and necessary interventions for improvement.
They touch upon the waiting system and risk adjustment incorporated in the tool, which allows schemes to reflect their demographic profile and compare their results to the industry on a like-for-like basis. The tool focuses on specific areas of coverage such as maternity care, child health, noncommunicable diseases (hypertension, diabetes, mental health), infectious diseases (HIV prevention, pneumonia in the elderly), and cancers (breast and cervix).
Dr. Patel mentions that the tool is new and currently being launched, with 10 participating schemes and 4 schemes already using it for management purposes. The goal is to empower schemes to make informed decisions about benefit design based on health needs, ultimately improving the health status of members. The tool's data can also be used to demonstrate value to employers, linking improved health to productivity and absenteeism in the workplace.
The conversation highlights the importance of employers as stakeholders and the need to demonstrate the value that schemes bring to companies and their employees. They emphasize the role of schemes in contributing to a healthy community and a healthy economy. The discussion concludes on a positive note, with Valle expressing gratitude for the insights gained from the conversation.