YOU NEED YOUR MEDICAL AID NOW MORE THAN EVER

In these difficult economic times it is only reasonable to look at areas where we can cut down on our expenditure. The household budget is still under pressure even if the interest rates have dropped a bit and fuel is no longer as cripplingly expensive as it was last year.

Many members, particularly those who are fortunate enough to be healthy, seriously consider dropping off their medical aid in order to save. This approach is really shortsighted and I would urge anyone trying to balance the household budget to only consider resigning from a medical scheme as a last resort.

We are faced with the daily risks of road accidents and the trauma of crime, while certain diseases seem to spread unchecked. Even if you are young and healthy the likelihood of being injured or contracting some life-threatening disease are very real possibilities. The costs of treatment simply continue to escalate. Even relatively minor treatment can be beyond the average household’s ability to pay for it from their own pockets. Which then puts people not belonging to a medical aid at the mercy of the state facilities. And while we have every faith in the efforts of the new health minister and while we admire the dedication of staff in those facilities, the reality is that the service and apparatuses at those facilities leave much to be desired.

At Fedhealth we are well aware that medical aid is expensive but we understand that you, the member, is being responsible and prudent in belonging to a medical aid that offers real benefits when you need them most. We also strive to add value through the addition of benefits like the Trauma Management Programme and Petsure.

Belonging to Fedhealth is ensuring peace of mind – that you and your family will be taken care of no matter what life throws at you.

Tell us why you stay part of our family!

Maybe a great benefit came through for you in times of need, or perhaps you really liked the friendly and warm service you received. Whatever it is, please submit your reason or reasons to housecall@thecheesehasmoved.com so we can share them with all our members.

We introduced this feature last month to bring home to you great reasons for belonging to the Fedhealth Family. We live up to our ethos of providing REAL MEDICAL AID and part of this philosophy means that we need to keep you updated on how we offer better value than other schemes in the market.

We received some great responses from members on last month’s article:

"One of the most important reasons for staying with Fedhealth is the fact that I can keep my 21 year old daughter on the scheme at child dependant rates until she is 27. She has been studying at University and only finishes when she is 24. It gives me peace-of-mind knowing that she will be covered until she can join a medical aid herself."

"Fedhealth is not only a medical aid society, but a business with a "soul", that really cares for their members, not just their bottom line."

REASON NO.2

Fedhealth pays for specialised radiology like MRI and CT scans from Risk and not Savings, whether performed in or out-of-hospital. This benefit is unlimited.

Implications:
Specialised radiology is sometimes vital in the correct diagnosis of serious illnesses. These are expensive procedures which could range from R3 000 to R12 000 depending on the specific scan. No matter when your doctor or specialist refers you for a scan, the cost will be paid by the scheme from Risk and will never be deducted from your OHEB or Savings, leaving you with more funding for your day-to-day requirements.

Other schemes:
Discovery Health: The first R1 800 for an MRI or CT scan is paid from day-to-day benefits with the balance being paid in full at the Discovery Health Rate.

Many other schemes that we investigated offer a limited combined benefit for specialised radiology performed either in or out of hospital.

Tip: Remember that Specialised Radiology performed out-of-hospital needs to be pre-authorised by the Hospital Management Authorisation Centre. Call them on 0860 103 951.

Understanding your Fedhealth benefits

Knowledge is power and with this new feature we would like to empower our members to make the most of their benefits through understanding how it all works.

This month, we will begin with an overview of all of your benefits; what they are, where they are paid from and the tariffs at which they are refunded. The diagram below, the product circle, is one with which you are probably quite familiar. We use the product circle in the Member Guide which we send to new members when they join the scheme.

The risk benefits comprise of the following: In-Hospital Benefit, Chronic Disease Benefit, the Out-of-Hospital-Expenses Benefit and the Safety Net Benefit.

What is the In-Hospital Benefit?
The In-Hospital Benefit funds your hospitalisation expenses at cost up to 300% of the National Health Reference Price List (NHRPL) from day one with no overall annual limits. Sub-limits may apply on certain procedures and these limits may differ from option to option. Please consult the In-Hospital Benefit table in the October 2008 issue of HouseCall!, or go to www.fedhealth.co.za or call the Call Centre on 0860 002 153 for full details.

NHRPL – This is a reference price list published each year by The Council for Medical Schemes which provides a guideline to tariffs charged by healthcare professionals. Historically, this was known as the Medical Aid Rate or Scale of Benefits. A healthcare professional “contracted in” would generally abide by this guide and charge at the guideline tariff.

What is the Chronic Disease Benefit?
The Chronic Disease Benefit funds medications for listed diseases (which include the 25 Prescribed Minimum Chronic Diseases). The medication will be funded up to your chronic disease benefit limit at the lower of cost or MPL (Medicine Price List), where applicable. Please consult the Chronic Disease Benefit table in the October 2008 issue of HouseCall!, or go to www.fedhealth.co.za or call the Call Centre on 0860 002 153 for full details.

MPL – This is a reference price list that benchmarks each product against generically similar products. It does not restrict member’s choice, but limits the amount that the scheme will refund for each product. The MPL reference price is set at a level to ensure that a number of medicines will be available without any co-payment.

What is the Out-of-Hospital Expenses Benefit (OHEB)?
The OHEB is risk benefit that pays for certain of your day-to-day expenses. Claims are paid from this benefit up to 100% of NHRPL. If your claim is in excess of NHRPL, the balance will be paid from your savings account up to cost, providing you have funds available.

What is the Safety Net benefit?
The Safety Net Benefit is a risk benefit designed to protect members from unusually high day-to-day expenses. The Safety Net Benefit is reached by the accumulation of claims paid from either OHEB, savings or by yourself. Once in Safety Net, claims are paid from this benefit up to 100% of NHRPL, subject to certain limits. Please consult the Day-to-Day Benefit table in the October 2008 issue of HouseCall!, or go to www.fedhealth.co.za or call the Call Centre on 0860 002 153 for full details.

What is savings?
A portion of your contribution is allocated to a personal savings account. The funds available in this account may be used for day-to-day medical expenses. The amount not used at year-end is carried forward and is available for day-to-day expenses in the following year.

In the coming issues of HouseCall!, we will expand on each of these benefits in greater detail and the March issue will feature the Out-of-Hospital-Expenses Benefit.

Head injury or Traumatic Brain Injury (TBI) occurs when a sudden physical assault on the head causes damage to the brain. The damage can be confined to one area of the brain or involve more than one area of the brain. Head Injuries can result from a closed head injury or a penetrating head injury. Symptoms may include headache, nausea, confusion, a change in personality, depression and irritability. Persons with head injury need a systematic yet rapid evaluation.

A closed head injury occurs when the head suddenly and violently hits an object, without the object breaking through the skull.

A penetrating head injury occurs when an object pierces the skull and enters the brain tissue.

Symptoms
Symptoms of a head injury may include headache, nausea, confusion or other cognitive problems, a change in personality, depression, irritability, and other emotional and behavioural problems. Some people may have seizures as a result of a head injury.

Diagnosis
CT scanning is the gold standard for the radiologic assessment of a head-injured patient. A CT scan is easy to perform and is an excellent test for detecting the presence of blood and fractures, which are the most important lesions to identify in emergency situations.

Plain x-rays of the skull are recommended by some people as a way to evaluate patients with only mild neurologic dysfunction. However, most large centres in South Africa have readily available CT scanning, which is a more accurate test. For this reason, the routine use of skull x-rays for head-injured patients has declined.

Magnetic resonance imaging (MRI) is not commonly performed for acute head injury because it takes longer to perform than a CT scan, and because transporting an acutely injured patient from the emergency room to the MRI scanner is difficult.

However, after a patient has stabilised, MRI may demonstrate the existence of lesions that could not be detected by CT. Such information is generally more useful for determining prognosis than for influencing treatment.

Prognosis
The outcome of TBI depends on the cause of the injury and on the location, severity, and extent of neurological damage: outcomes range from good recovery to death. Doctors often use the Glasgow Coma Scale to rate the extent of injury and chances of recovery.

The scale (3-15) involves testing for three patient responses: eye opening, best verbal response, and best motor response. A high score indicates a good prognosis and a low score indicates a poor prognosis.

Treatment
Like all trauma patients, persons with head injury need a systematic yet rapid evaluation in the emergency room. Cardiac and pulmonary functions are the first priority. Next, a rapid examination of the entire body is performed.

Immediate treatment for head injuries involves surgery to control bleeding in and around the brain, monitoring and controlling intracranial pressure, insuring adequate blood flow to the brain, and treating the body for other injuries and infection.

Some contusions or haematomas may enlarge over the first hours or days after head injury, so that some patients are not taken to surgery until several days after an injury. Sometimes these delayed haematomas are discovered when a patient’s neurologic exam worsens or when the ICP increases.

On other occasions, a routine follow-up CT scan that was ordered to see if a small lesion has changed in size indicates that the haematoma or contusion has enlarged significantly. In many of these cases, removing the lesion before it enlarges and causes neurologic damage may be safest for the patient.

Findings in the US forewarns of a possible trend in our own country

When you think of kidney stones, children don’t usually come to mind. But doctors say they’re seeing increasing numbers of children with the painful condition, and it could represent more fallout from the obesity epidemic.

While exact numbers of children with kidney stones are elusive, physicians at children’s clinics say the numbers are up. “There is very little available on paediatric stone disease in particular,” said Dr Caleb Nelson, a urologist at Children’s Hospital Boston. “Most data has looked at adults or the entire population.”

Still, Nelson and other experts are certain there are more kids with kidney stones, despite hard numbers.

“Proposed reasons include sedentary lifestyle, obesity increase, processed high-salt diets,” Nelson said.

A kidney stone is a hard mass that results when calcium oxalate or other urinary chemicals form sticky crystals. The crystals grow and become stones that can range in size from a grain of sand to a golf ball, according to the National Kidney Foundation.

There’s not much that parents can specifically do to prevent kidney stones in their children, Nelson said. They can encourage their kids to follow an overall healthy lifestyle, which can help reduce the risk. “Eat a balanced diet,” he said. “Drink lots of non-caffeinated liquids. Get exercise.”

If you suspect your child has kidney stones, get medical attention. Your paediatrician may order X-rays or tests with sound waves, or specialised X-ray techniques to detect stones. Blood and urine tests may also help the doctor decide what is causing the stone and the best treatment option, according to the kidney foundation.

Tribute to the man who discovered the cause of Down Syndrome

On March 21, 2009, World Down Syndrome Day will mark the 50th anniversary of the publication of Professor Jerome Lejeune’s discovery of the extra copy of chromosome 21 which causes Down Syndrome.

Now known as trisomy-21 because of the third copy of the 21st chromosome, Down Syndrome was first described by the English doctor, John Langdon Down, in 1866 but until Professor Lejeune’s publication in 1959, the ultimate cause of Down Syndrome was unknown. Read more at www. worlddownsyndromeday.org or visit health24.com for more information.

More than 300 cases of drug resistant TB in SA

A total of 303 cases of extreme drug-resistant tuberculosis (XDR-TB) have been confirmed across South Africa according to the national Health Department.

263 cases in KwaZulu-Natal, 10 cases each in the Eastern Cape and the North West, 9 in Gauteng, 6 in the Free State, 3 in Limpopo and 2 in the Northern Cape were recorded. None were reported in Mpumalanga and the Western Cape. The statistics were released by the department’s head of TB, Dr Lindiwe Mvusi.

Source health24.com – visit the site for more TB info including symptoms and advice

Celebrating International Women’s Day

International Women’s Day is a major day of global celebration for the economic, political and social achievements of women past, present and future. Annually on 8 March, thousands of events are held throughout the world to inspire women and celebrate achievements. In our own country it is also time to think about the women who are inspiring fashion and creating art and crafts that rival the best in the world. So make a difference, think globally and act locally. Make everyday International Women’s Day. Do your bit to ensure that the future for girls is bright, equal, safe and rewarding.