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Aleesha Reddy | Healthcare Insurance Claims: the next frontier of trends and predictions emerge

 

Aleesha Reddy | Healthcare Insurance Claims: the next frontier of trends and predictions emerge
14-02-24 / Aleesha Reddy

Aleesha Reddy | Healthcare Insurance Claims: the next frontier of trends and predictions emerge

As we journey further into 2024, the healthcare landscape is evolving at an unprecedented pace, shaped by a confluence of factors ranging from technological advancements to the profound impact of climate change. Understanding and adapting to these trends is crucial for both healthcare providers and consumers. Here, we delve into five key healthcare trends for the 2024 and beyond:

  1. Empowering choices: Out-of-Pocket expenditure

It is apparent that medical scheme members opting for flexibility in their selection of specialists and hospitals will persist in facing substantial out-of-pocket claims expenditure. Navigating this financial terrain, the significance of having comprehensive gap cover cannot be overstated. It plays an important role in providing members with a financial safety net, addressing unexpected hospital co-payments, and bridging shortfalls in specialist costs. In this era of evolving healthcare dynamics, ensuring a balance between flexibility of choice and financial preparedness becomes paramount, placing gap cover as an indispensable ally in the pursuit of optimal and sustainable healthcare outcomes.

  1. Streamlining resources: Day-to-day benefit limits

In a strategic move aimed at curbing unnecessary day-to-day healthcare spending and mitigating the potential misuse of benefits, a multitude of medical schemes and primary healthcare providers have instituted mandatory pre-authorisations upon reaching specified benefit limits.

Simultaneously, they've tightened controls surrounding network utilisation, focusing notably on GP and dental benefits. While these measures seek to enhance the sustainability of healthcare systems, it's important to acknowledge that such additional controls may inadvertently lead to treatment delays or heightened claim rejections, particularly when members deviate from the prescribed scheme rules. As we navigate this delicate balance between fiscal responsibility and optimal patient care, it becomes imperative to foster a nuanced understanding of these evolving dynamics within the healthcare ecosystem.

  1. Virtual care: A catalyst for transformation

The prevalence of virtual care is set to surge across diverse disciplines. While its adoption has historically been prominent in nurse-led and GP consultations, a transformative shift is underway as virtual care gains traction among healthcare professionals such as dentists, dermatologists, and allied healthcare practitioners.

This extends beyond conventional use, encompassing tasks like patient diagnosis, treatment plan formulation, and seamlessly complementing in-person care. The cost-effectiveness inherent in virtual care positions it as a proactive tool, poised to be leveraged by individuals for the effective management of their day-to-day benefits. As the synergy between technology and healthcare deepens, virtual care emerges as a cornerstone in fostering accessibility, efficiency, and patient-centricity in the evolving landscape of healthcare services.

  1. Climate change and healthcare: Preparing for the unforeseen

According to Council for Scientific and Industrial Research (CSIR)[1] we're facing the global onset of an El Niño period, a pivotal juncture unfolds, amplifying the risk of heatwaves and wildfires. This climatic shift heralds a significant implication for healthcare, with projections indicating a potential upswing in hospital admissions throughout 2024. Anticipated repercussions include an elevated incidence of cases related to smoke inhalation, burns, and heat-related illnesses, notably heat stroke.

As we navigate this intersection of climate and healthcare, a proactive approach to managing and mitigating the health impacts of environmental shifts becomes paramount in ensuring the resilience and well-being of communities.

  1. Precision and progress: Robotic assisted procedures

The year 2023 witnessed a notable surge in the upgrading of robotic surgery systems across numerous hospitals. These advanced systems, surpassing their predecessors in versatility, are now capable of assisting with a broader spectrum of medical procedures. This signals a new era in surgical interventions, epitomising the commitment of healthcare to embrace cutting-edge technologies for the betterment of patient care and recovery.

The transformative impact of robotic-assisted procedures extends to enhanced patient outcomes, characterised by heightened precision and reduced invasiveness, translating to shorter recovery times. The momentum gained in the previous year sets the stage for a continued ascent in 2024 and beyond, with the anticipated rise in the occurrence of robotic-assisted procedures.

*Aleesha Reddy is Head of Product Development at NetcarePlus.

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