High risk, high contributions: Why medical scheme legislation needs a revamp

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Tipping the scales: Lifestyle diseases come at great cost to both the economy and medical schemes.

03 May 2017: The cost of health care continues to vastly outpace inflation in most major economies, and research shows that soaring medical expenses are largely driven by claims related to lifestyle choices, such as smoking, a lack of exercise and a poor diet.

“Our modern lifestyles have an impact on our health – we’re more stressed, we have easy access to sugars and fats, many of us smoke cigarettes or drink alcohol, and many of us don’t exercise as part of our daily routines,” says Graham Anderson, CEO and principal officer of Profmed. 

“All of this contributes to an increased risk to our health, taking the form of very specific lifestyle diseases,” he says, “specifically heart disease, stroke, diabetes, obesity, metabolic syndrome, chronic obstructive pulmonary disease, and some types of cancer.”

Unsurprisingly there is more focus on the human costs of lifestyle diseases than the economic and financial impact, but according to studies by the World Health Organisation (WHO), the negative burden of chronic illnesses can be highly significant. 

Research has shown that economies with better health conditions enjoy a positive and direct impact on economic growth, largely through increased worker productivity.

This is without considering the decreased cost of healthcare and precautionary measures.  

‘Chronic disease can result in loss of independence, years of disability, or death, and impose a considerable economic burden on health services, Anderson says. 

Statistics also show that lifestyle-related illnesses used to be largely contained to developed countries or considered diseases of affluence; however, it has become an international phenomenon, affecting more people at a faster rate in emerging economies.   

The prevalence of subsequent chronic diseases in South Africa have become so overwhelming that local hospitals are too overburdened and under-resourced to cope and the poor education and lack of understanding of many patients has made preventive measures difficult. 

“ Even medical scheme members who are most seriously at risk do not even consider the harm they are doing to themselves, and  are probably unaware that their bad habits are not only costing them more in their health insurance but that it also contributes to a greater chance of chronic conditions,” Anderson says. 

That is why it has become so important to change the way we live our lives and make sure that we:

  • Exercise moderately at least: Even a half hour’s brisk walk a day is enough to improve your health;
  • Eat the right foods: Avoid fatty foods and too many processed carbs and sugars, eat good proteins – preferably grilled rather than fried – and not too much red meat, eat plenty fresh fruit and vegetables.
  • Get enough sleep: Try to get around eight hours of sleep a night. It reduces stress and inflammation, helps regulate your appetite and reduces your risk for depression and heart conditions.
  • Drink enough water: Try for around eight glasses of water a day. Most people don’t drink as much water as they should. Although other beverages are hydrating, they introduce other substances into your body, which defeats the point of flushing out your system.
  • Reduce stress: It’s a good idea to try and manage your life if you find that you are feeling overwhelmed or running on empty. Speak to a therapist or a life coach if you really can’t find a way to make the changes you know you need.
  • Give up smoking: There is no debate about the link between cancer and smoking, and there is no healthy amount to smoke.
  • Drink alcohol only in moderation: Drink no more than one or two drinks a day – and these daily drinks can’t be rolled over to the weekend. Always drink with food and space your drinks if you are drinking more.
  • Treat existing conditions: So many lifestyle diseases create greater risks for others – for instance there is a clear link between diabetes, heart disease and strokes. If you have one condition, take it seriously, and if you are in a high-risk group – for instance, have high blood pressure – make sure that you manage your condition.


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