The Western Cape health department has signed a one-year agreement with Pro Sano, one of the country's major medical aid schemes, in a deal which will see state hospitals cashing in on medical aid funds.
This deal is being touted as a blueprint for what is going to happen next year when medical aid schemes will have the right to tell their members to go to public hospitals, instead of expensive private care facilities.
Lionel Kearns, chairperson of Pro Sano health committee, has welcomed the agreement, which was signed on Monday.
"This deal will enable us to contain the health care costs," said Kearns.
The agreement will enable Pro Sano to save money by referring patients to the less expensive state hospitals.
This service is levied at the uniform patient schedule whose rates are approximately 25 percent cheaper than the Board of Health Care Funders, the body to which schemes belong.
Japie du Toit, business manager for the Health Department, said: "The basis of this agreement is to offer guaranteed access to health care facilities. However, patients will have to go to appropriate hospitals."
Certain state hospitals in the province, including Groote Schuur and those in Vredendal and Worcester, form part of the deal, which will enable medical aid scheme members to use hospital facilities.
In the long term, cash-strapped state hospitals will make some money by tapping into the lucrative medical aid industry.
In anticipation of this deal, the state hospitals in the province have upgraded certain wards for the exclusive use of the medical aid members.
This agreement is the first between the government and a medical aid scheme and is being used as a model for other provinces.
The benefits for members under the new deal will include expensive specialist services such as radiology and pathology.
The Pro Sano medical scheme has more than 120 000 members nationally, 78 000 of which are in the Western Cape.
The challenge now, said Kearns, was to encourage their members to use the cheaper state hospital facilities to ensure the survival of the medical aid schemes.
Du Toit admitted that they were facing a huge challenge in changing perceptions about the quality of health care at state hospitals.
In the past few years, said Du Toit, the infrastructure in public hospitals had been falling apart while the attitude of staff had been questionable.
"Its not feasible to upgrade all the hospitals at once but we can select staff with good attitude to work on the up-graded wards," said Du Toit.
- In the past financial year, the health department has collected R120 million from medical aids.