Botswana Medical Aid Funds 2019 Annual Report

The Botswana Medical Aid Funds

2019

ANNUAL REPORT

B

The Botswana Medical Aid Funds ANNUAL REPORT 2019

2019 ANNUAL REPORT Botswana Medical Aid Funds Prepared by the Board of Healthcare Funders

The Board of Healthcare Funders (BHF) is pleased to present this report on medical aid funds in Botswana.

This is the first report prepared by the BHF for medical aid schemes from the SADC region. It is a useful tool for measuring the performance of these funds and highlights their contribution to the health of the population.

ANNUAL REPORT 2019 The Botswana Medical Aid Funds

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Contents 1

EXECUTIVE REPORTS

02

Executive summary

04

Message from the Managing Director of the BHF

06

Message from Chairman of the Botswana Association of Medical Aid Funds

08

Message from the BHF Botswana Country Representative

2

MEDICAL AID FUNDS REPORTS

10

Medical aid funds’ membership

13

Medical aid funds’ disease burden

16

Medical aid funds’ quality of care

19

Medical aid funds’ healthcare expenditure

24

Out-of-pocket expenditure

26

Medical aid funds’ financial performance

3

Annexures and References

28

Annexure A: Medical aid fund beneficiaries

29

Annexure B: Consolidated financial statements

30

List of tables

31

List of figures

31

List of acronyms and abbreviations

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The Botswana Medical Aid Funds ANNUAL REPORT 2019

EXECUTIVE SUMMARY In 2019, there were five medical aid funds in Botswana registered with the NBFIRA, the same as in 2018.

Of the five medical aid funds registered with the Non-Banking Financial Institutions Regulatory Authority (NBFIRA) in Botswana, four are members of the Board of Healthcare Funders (BHF) and submitted data for the preparation of this report. These four funds represent approximately 95% of the lives covered by medical aid funds in Botswana.

There were 327 500 beneficiaries covered by these four funds in 2019, up from 309 500 in 2018 – representing an increase of 5.8%. The average family size in 2019 was 2.32. The average age of beneficiaries in-

Beneficiaries (of the four funds)

creased slightly from 29.43 in 2018 to 29.52 in 2019, while the pensioner ratio increased marginally from 2.68% in 2018 to 2.89% in 2019.

Across the four funds, there were 30 benefit options in 2018 and 29 benefit options in 2019. The average number of options was therefore 7.25 in 2019. The average option size (by number of beneficiaries) increased by 9.5% from 10 317 in 2018 to 11 293 in 2019.

The funds received gross contributions of P1.92 billion in 2019, up from P1.76 billion in 2018, an increase of

GROSS CONTRIBUTIONS

GROSS expenditure

5.8%

9.2%

9.4%

327 500 (2019) 309 500 (2018)

P1.92bn (2019) P1.76bn (2018)

P1.64bn (2019) P1.50bn (2018)

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ANNUAL REPORT 2019 The Botswana Medical Aid Funds

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average option size 2019: 11 293 2018: 10 317

 average monthly contribution 2019: P490 2018: P475

9.2% year on year. Gross healthcare expenditure increased by 9.4%, from P1.50 billion in 2018 to P1.64 billion in 2019. The reserves of these funds, calculated as a proportion of gross annual contributions, grew from 50.6% in 2018 to 51.6%% in 2019.

In 2018, non-healthcare expenditure represented 13.2% of gross contributions. Non-healthcare expenditure declined in monetary terms from P63 pbpm to P54 pbpm from 2018 to 2019. This makes available more financial resources for healthcare expenditure and contributes towards affordability.

The average contribution per beneficiary per month (pbpm) was P490 in 2019 while in 2018 it was P475, increasing by 3.2% from 2018 to 2019. Annual inflation as measured by the consumer price index increased by 2.85%; contribution increases were therefore 0.35% higher compared to inflation. Affordability of medical aid fund cover is important as it improves long-term sustainability.

In 2019, claims submitted to medical aid funds amounted to P2.02 billion while P1.61 billion was paid in respect of these claims. Out-of-Pocket (OOP) expenditure by beneficiaries was at least P403 million.

This OOP expenditure represented approximately 20% of total healthcare expenditure in 2019, higher than the WHO’s recommended limit of 15%.

Healthcare expenditure by medical aid funds in 2019 was P418 pbpm, representing 85% of the gross contributions received in 2019. Non-healthcare expenditure accounted for 11.0% of gross contributions in 2019.

Charlton Murove BHF Research: Head

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MESSAGE FROM Dr Katlego Mothudi bhf MANAGING DIRECTOR Regional Member Services BHF provides the following services for its members in the region  Access to discounted rates for the Wits Business School / BHF Trustee Development Programme  Access to discounted rates to the BHF Annual Conference  Legal Services on issues of common interest  Country Annual Reports  Fraud waste and abuse frame work  Fraud waste and abuse collaborative portal  Access to the Practice Code Numbering System at discounted rates  Industry benchmarking research PREPARED BY The BOARD OF HEALTHCARE FUNDERS NPC

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ANNUAL REPORT 2019 The Botswana Medical Aid Funds

T

he Board of Healthcare Funders is pleased to present this report on medical aid funds in Botswana. This is also the first report prepared by the BHF for medical aid schemes from the Southern African Development Community (SADC) region. It is a useful tool for measuring the performance of these funds and highlights their contribution to the health of the population.

The SADC countries have the attainment of Universal Healthcare Coverage (UHC) as an objective. The BHF’s effective coverage tool for its membership in the region measures progress towards the attainment thereof. The BHF therefore recommends that member schemes adopt effective coverage.

The BHF’s strategic focus includes providing value to its members and this entails assisting members to provide maximum value to their beneficiaries. To achieve this, the BHF advocates and advises its membership to implement progressive health policies.

Regional integration is important and harmonising local industry policies is vital to achieving the desired outcomes. These include improved health outcomes and reducing the impact of Fraud Waste and Abuse (FWA) in the region.

This report measures the growth of medical aid funds in respect of membership and financial performance. These metrics are a proxy indicator of the performance and sustainability of medical aid funds in Botswana. They provide a strong basis from which the funds may expand their membership and provide better value for beneficiaries. During this reporting period, the funds’ membership grew and their financial performance was strong.

We have included measures of the medical fund industry’s risk profiles. This is useful for future planning and the establishment of industry-wide responses to challenges. The average age of beneficiaries was relatively low – about 29 years; in South Africa the average age is approximately 32 years. Similarly, the pensioner ratio is also low, at about 3%. The disease burden faced by the funds is high and on the

REPORT HIGHLIGHTS  Metrics to measure the growth of medical aid funds in Botswana

 Assessment of the performance and sustainability of medical aid funds

 Measures of the risk profiles of the medical fund industry

 Measures of quality of care, an important component of UHC

 Measure to track out-of-pocket ex-

penditure by medical aid beneficiaries

increase; the prevalence of HIV and cardiovascular conditions is very high. These funds need to put in place health interventions to manage these conditions to limit their effects on sustainability.

Included in this report are measures of quality of care, an important component of UHC and in most cases an aspirational goal. Achievement thereof requires continuous improvement. The components of quality of care included in the report are measures of the proportion of chronic beneficiaries receiving minimum standards of care. It is important that as an industry we continue measuring these, together with service providers. This not only leads to better health outcomes but also improves the long-term sustainability of funds. Healthy beneficiaries tend to claim less and contribute to medical aid funds for longer.

Another key measure included in this report is OOP expenditure by medical aid beneficiaries. Healthcare costs can be catastrophic and lead to financial ruin of households. Limiting OOP payments is crucial to the attainment of UHC. In this report, OOP expenditure was estimated as the difference between the total claims submitted and the total paid by medical aid funds.

Dr Katlego Mothudi BHF Managing Director

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MESSAGE FROM Lesego Pule

Chairman of the Botswana Association of Medical Aid Funds KEY STRATEGIC GOALS We strive to serve & promote the common interests of our members

• Ensuring sustainability of the healthcare sector • Advocating policy positions • Creating economies of scale to enable members to deliver value to their membership in return • Providing stewardship and thought leadership • Facilitating private sector participation in achieving universal health coverage • Driving fraud waste and abuse framework implementation

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ANNUAL REPORT 2019 The Botswana Medical Aid Funds







Registered Medical Aid Funds

Our Members

Our Stakeholders

 Botswana Medical Aid (Bomaid)

 Botswana Medical Aid (Bomaid)

 Government

 Botswana Public Officers’ Medical Aid Scheme (BPOMAS)

 Healthcare professionals

 Botswana Public Officers’ Medical Aid Scheme (BPOMAS)  Doctors (Pty) Ltd t/a Doctors Aid Medical Aid Scheme  Pula Medical Aid Fund

 Regulator (NBFIRA)

 Pula Medical Aid Fund

 Medical aid fund members

 Botsogo Health Plan

 Employer groups

 Botsogo Health Plan

A

s an industry we are very excited about the report and would like to take this opportunity to thank the Board of Healthcare Funders for championing this project in Botswana. This report will serve to assist us in achieving our strategic goals.

Medical aid funds (MAFs) in Botswana are licensed by the NBFIRA, which regulates and supervises MAFs. Five funds are registered with the NBFIRA. At present, there are no subordinate regulations for the licensing and monitoring of MAFs. In 2018, the Health Funders Association Botswana (HFAB) was successfully revived. As an association our aim is to drive the improvement of the quality of healthcare in Botswana, and create access to affordable health services to the population.

Lesego Pule Chairman of the Botswana Association of Medical Aid Funds

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The Botswana Medical Aid Funds ANNUAL REPORT 2019

COUNTRY REPORT BACK Moraki Mokgosana BHF Botswana country representative

I

n terms of health and development, Botswana has made progress in improving geographical access to health services, including almost universal access to antiretroviral delivery and prevention of mother-tochild transmission.

The country has adopted the Universal Healthcare Coverage concept and, as an industry, our aim is to play a meaningful role towards achieving this global agenda.

During this period, we saw the implementation of the amended Botswana Financial Intelligence Act of 2018.

With the introduction of this act, all institutions are expected to exercise due diligence with all their stakeholders to minimise the use of medical aid fund systems for money laundering activities.

Industry growth remained fairly stagnant due to a number of factors, such as the slowdown in economic growth and the closure of some of the country’s major mines. New mining ventures are expected to be revived on the horizon.

INDUSTRY HIGHLIGHTS 

Increase in healthcare costs



Lack of growth



Fraud, waste and abuse



Student visa requirements in South Africa



Regulatory gaps

We are honoured as Botswana to be part of the BHF board. This has provided opportunities to promote regional collaboration, as well as access to a wealth of industry experts through learning from other well-established institutions.

MORAKI MOKGOSANA BHF Botswana country representative

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ANNUAL REPORT 2019 The Botswana Medical Aid Funds

Medium term goal Fully aligned ecosystem where member needs are driven by all stakeholders

Value chain alignment

Medium term goal Be the trusted driver of health system reform that incorporates all stakeholders

Medium term goal Proactively drive content and position BHF as the industry thought leader

Thought Leadership & Brand

Universal Health Coverage

Medium term goal Generate more revenue whilst fundamentally serving our members

Financial Stability

strategic DRIVERS of the THE BHF Collaborative innovation Stakeholder participation BHF internal processes and structures Vulnerable members’ support Inter-operable industry

Shaping NHI Medical Scheme reform Member expectations

Relevant research BHF Conference relevance Product improvement BHF Academy Industry information hub BHF brand building

Revenue generating principles Membership, fees and structure Training offerings Consulting and research offering Conferencing offering Joint industry issue resolution Associate membership

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The Botswana Medical Aid Funds ANNUAL REPORT 2019

Medical aid funds’ membership On 31 December 2019, 327 500 beneficiaries belonged to the four funds included in this report. The number increased from 309 500 in 2018 to 327 500 in 2019, equivalent to an annual growth rate of 5.8%. This increase in membership is largely attributable to growth in the number of child dependents by 8.8% from 2018 to 2019. Figure 1 highlights the overall beneficiaries in 2018 and 2019.

There were more female than male beneficiaries in both 2018 and 2019. This applies to both principal members and their dependents. The number of adult

dependents is very low, representing only 28% of all adult beneficiaries in 2019.

Risk pooling There were 30 and 29 benefit options in 2018 and 2019, respectively, across the four funds. The smallest benefit option had approximately under five beneficiaries while the largest had approximately 157 000 beneficiaries.

Benefit option size is important as larger options provide better risk pooling. Figure 2 shows the size of benefit options in 2018 and 2019.

Principal

Adult

Two very large options account for more than half of beneficiaries.

The remaining options are much smaller and share the remaining beneficiaries. The risk pooling is rather fragmented.

Table 1 shows the summary of benefit options in the same period. The average number of benefit options across all four funds in 2018 and 2019 was 7.5 and 7.25 per fund, respectively.

Family size Of the 327 500 beneficiaries in 2019, 141 305 were principal

Child

133 391

122 641

61 916 20 140

60 725

66 825

68 572

M

F

31 328

51 468 67 223

66 168

135 397

20 757

32 030

69 197

72 108

TOTAL

M

F

2018

Figure 1: Medical aid fund beneficiaries

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2019

52 787 141 305

TOTAL

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ANNUAL REPORT 2019 The Botswana Medical Aid Funds

Figure 2: Benefit option sizes members, 52 787 were adult dependents and 133 391 were child dependents. Table 2 provides additional detail on the beneficiary profile from 2018 to 2019.

The dependent ratio measures the average number of depend-

ents per principal member. It increased from approximately 1.29 dependents per principal member in 2018 to 1.32 dependents per principal member in 2019. This indicates a slight increase in the number of dependents per principal member.

Risk profile of beneficiaries The risk profile of beneficiaries is important to monitor. Older beneficiaries tend to claim more than younger ones. For medical aid funds to be sustainable, there

Year

Number of funds

Minimum number of options per fund

Maximum number of options per fund

Average number of options

2018

4

3

12

7.5

2019

4

3

12

7.25

Table 1: Summary of benefit options in 2018 and 2019 Dependent Type

2018

2019

% increase

Principal

135 397

141 305

4.4%

Adult

51 468

52 787

2.6%

Child

122 641

133 391

8.8%

Total

309 506

327 483

5.8%

Table 2: Number of beneficiaries by dependent type

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The Botswana Medical Aid Funds ANNUAL REPORT 2019

must be enough cross-subsidisation between younger and older beneficiaries.

The average age of beneficiaries in 2019 was 29.52 years, while the pensioner ratio (proportion of beneficiaries aged 65 or more) was 2.89%. The average age increased slightly in 2019; it was 29.43 in 2018. The pensioner ratio also increased marginally from 2.68% in 2018. Table 3 shows

Female Male Total

the average age of beneficiaries by gender and pensioner ratio.

Figure 3 shows how the age profile of beneficiaries changed from 2018 to 2019.

aged 5-9 years in both 2018 and 2019, compared to other ages.

The age range 35-49 also accounted for a significant proportion of beneficiaries.

Membership was low in the age band 20-29 in both 2018 and 2019. Beneficiaries in this age range tend to claim less, thus contributing positively to the risk pool.

Figure 3 further shows that there is consistent growth in beneficiaries aged 35 and above. This is a concern as beneficiaries in age bands over 50 years tend to have a higher average healthcare cost, relative to their contributions.

There were more beneficiaries

Risk profiles

2018

2019

% change

Average age

29.70

29.79

0.30%

Pensioner ratio

2.54%

2.74%

7.67%

Average age

29.13

29.23

0.35%

Pensioner ratio

2.83%

3.05%

7.79%

Average age

29.43

29.52

0.33%

Pensioner ratio

2.68%

2.89%

7.72%

Table 3: Average age and pensioner ratios

NUMBER OF BENEFICIARIES

40 000 35 000 30 000 25 000 20 000 15 000 10 000 5 000 -

Figure 3: Number of beneficiaries by age band

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2018

2019

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ANNUAL REPORT 2019 The Botswana Medical Aid Funds

Medical aid funds’ disease burden The health of a medical aid fund’s membership is important as it impacts their healthcare needs and ultimately the fund’s claims experience. The prevalence of chronic diseases is increasing in sub-Saharan countries. It is therefore important to monitor this. Funds that actively manage these specified chronic conditions tend to register beneficiaries on their disease management programmes.

This section therefore focuses on the proportion of beneficiaries registered on these programmes. It also reports on the number of new beneficiaries registered during the

reporting period. These new registrations are an indicator of either the incidence of the chronic conditions, better screening by medical aid funds or both. It does, however, show the increasing disease burden for funds over time.

For the purposes of this report, the chronic conditions reported on are: • Human Immunodeficiency Virus (HIV).

• Diabetes mellitus (DM), including both type 1 and type 2.

• Respiratory (RES) conditions, including asthma and chronic obstructive pulmonary disease; and

PREVALENCE PER 1 000 BENEFICIARIES

F

• Cardiovascular (CVS) diseases, which include hypertension, coronary artery disease, cardiomyopathy, cardiac failure and ischaemic heart disease.

Chronic disease prevalence HIV remains the most prevalent chronic condition among medical fund beneficiaries. In 2019, the prevalence of HIV was 39.6 per 1 000 beneficiaries, compared to 39.9 per 1 000 beneficiaries in 2018. CVS-related diseases were the second most prevalent, with a prevalence of 27.9 per 1 000

M

33,65

33,57 25,54

24,21 45,60 4,33 5,93

7,54 6,34

RES

DM

27,06 CVS

PREVALENCE 2018

HIV

4,49 6,62

7,90 6,60

RES

DM

30,01

CVS

45,17

HIV

PREVALENCE 2019

Figure 4: Chronic disease prevalence

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The Botswana Medical Aid Funds ANNUAL REPORT 2019

beneficiaries in 2019. This is higher than the prevalence of 25.7 per 1 000 beneficiaries in 2018. Figure 4 highlights the prevalence of chronic conditions during the reporting period by gender.

number declined between 2018 and 2019. It is important to understand the reason for this.

respectively. The age profiles of beneficiaries are similar in both years. Most beneficiaries were in the age range 30-79 years, with the highest disease burden in the group aged 40-59.

The prevalence of respiratory disease and DM are very low; both have a prevalence of less than 10 per 1 000 beneficiaries in 2018 and 2019. The prevalence is higher among female beneficiaries compared to males for all chronic conditions reported on except DM.

CVS diseases had the highest number of new registrations compared to other chronic diseases.

An additional 3.84 per 1 000 beneficiaries were registered in 2019.

The number of new HIV registrations was also significantly high – 2.94 per 1 000 beneficiaries in 2019. DM recorded the lowest number of new registrations: 0.90 per 1 000 beneficiaries in 2019.

Chronic disease incidence

Chronic disease burden by age

HIV chronic beneficiaries are on average younger than CVS beneficiaries, which is to be expected. Beneficiaries with respiratory conditions have two peaks: in children and much older individuals. There are some children under five years of age with HIV, raising concerns about the success of mother-to-child transmission preventative interventions.

Figure 5 shows the number of new chronic beneficiaries registered in both 2018 and 2019. The

Figures 6 and 7 illustrate the age profile of chronic beneficiaries between 2018 and 2019,

Another concerning observation is the number of teenagers and young adults with HIV.

DM

CVS

HIV 3,84

2018

Figure 5: New chronic beneficiaries registered

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0,90

0,92

2,94

3,11 0,96

0,97

CHRONIC PER 1 000 BENEFICIARIES

4,07

RES

2019

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ANNUAL REPORT 2019 The Botswana Medical Aid Funds

Number of chronic beneficiaries

RES

DM

CVS

HIV

5 000 4 500 4 000 3 500 3 000 2 500 2 000 1 500 1 000 500 -

Age band

Figure 6: Chronic disease prevalence by age band in 2018

Number of chronic beneficiaries

RES

DM

CVS

HIV

6 000 5 000 4 000 3 000 2 000 1 000 -

Age band

Figure 7: Chronic disease prevalence by age band in 2019

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The Botswana Medical Aid Funds ANNUAL REPORT 2019

Medical aid funds’ quality of care Ensuring quality care is important and entails providing timeous, effective and affordable care to a patient when needed and within a safe environment. It directly impacts on the patient and their experiences. Ensuring quality of care essentially requires the patient to take responsibility and ownership for conditions that may need preventative interventions.

Healthcare funders also have a significant role to play in influencing the quality of care their beneficiaries receive. This section focuses on quality of care for chronic beneficiaries. The process measure to assess quality of care is the coverage ratio, i.e. the proportion of chronic beneficiaries receiving appropriate care, assessment or intervention.

In the case of chronic beneficiaries, there are some minimum interventions that must be applied during episodes of care. These interventions should be available to both stable and unstable patients, thus making them important markers of quality of care.

For instance, HIV beneficiaries must be monitored for viral load at least once a year. The coverage ratios of such interventions are monitored by the four chronic conditions discussed in this report.

Diabetes mellitus DM is a condition in which either the pancreas does not produce enough insulin (a hormone that regulates blood sugar or glucose), or when the body cannot effec-

tively use the insulin it produces. In 2018, the number of DM patients was 2 141, compared to 2 365 in 2019. This equates to a 10.5% increase across the funds included in this report.

The coverage ratios of diabetes are shown in Table 4 below.

Process and outcome indicators The minimum interventions in the care of diabetic patients are listed below: a) Creatinine/eGFR test: It is an important marker of kidney function. b) Haemoglobin A1c (HbA1c) Test: This test measures the amount of glucose in the blood over the past three months and

DIABETES

2018

2019

% change

Number of chronic beneficiaries

2 141

2 365

10.5%

Receiving at least one creatinine/eGFR test

35.8%

36.5%

2.0%

Receiving at least one HbA1c test

31.7%

30.4%

-3.9%

Receiving at least one cholesterol test

29.3%

30.1%

2.7%

17.7%

15.6%

-11.9%

Process indicator: Proportion of unique beneficiaries

Outcome indicator: Proportion of unique beneficiaries Admitted in hospital at least once Table 4: Diabetes coverage ratios

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ANNUAL REPORT 2019 The Botswana Medical Aid Funds

RESPIRATORY DISEASES

2018

2019

% change

Number of chronic beneficiaries

1 597

1 834

14.8%

Receiving a flu vaccine at least once

0.1%

0.1%

0.0%

Receiving a lung function test at least once

0.6%

0.2%

-61.3%

13.7%

13.1%

-4.6%

Process indicator: Proportion of unique beneficiaries

Outcome indicator: Proportion of unique beneficiaries Admitted to hospital at least once Table 5: Respiratory diseases coverage ratios is valuable because it is an indicator of disease control. c) Cholesterol test: This test detects the cholesterol and triglyceride levels in a patient’s blood.

The coverage ratios for monitoring tests such as the creatinine test were 36.5%, while those for the HbA1c and Cholesterol tests were 30.4% and 30.1%, respectively, in 2019. The coverage ratios for DM are suboptimal.

Respiratory conditions Respiratory conditions are defined as any chronic lung disease that results from obstructions in the airways of the lungs, and which leads to breathing problems.

For the purposes of this report, respiratory conditions refer to asthma and chronic obstructive pulmonary disease. The number of patients was 1 597 and 1 834 in 2018 and 2019, respectively. This translates to a 14.8% increase. The coverage ratios are shown in Table 5.

Process and outcome indicators The minimum interventions in the care of beneficiaries registered for respiratory diseases are listed below: a) Lung function test: This test measures respiratory function. b) Influenza vaccine: Respiratory patients are susceptible to complications if they contract the influenza virus. Vaccination is a preventative measure for such complications.

The coverage ratio for the lung function test was 0.1% in both 2018 and 2019. Furthermore, very few beneficiaries with respiratory conditions received the flu vaccine in both 2018 and 2019.

Cardiovascular diseases CVS diseases are those affecting the heart or blood circulatory system.

Those included in this report are hypertension, cardiac failure, cardiomyopathy, ischaemic heart disease

and coronary artery disease.

In 2018, the number of CVS chronic beneficiaries was 7 952, while in 2019 there were 9 126. This translates to a 14.8% increase. The coverage ratios for CVS conditions are shown in Table 6.

Process and outcome indicators The minimum interventions in the care of CVS patients are listed below: a) Electrocardiogram (ECG): The ECG is used to measure the electrical activity of the heart, which is important as it highlights irregularities and changes in function. b) Creatinine/eGFR test: This test measures the level of creatinine in the blood. It is an important marker of kidney function. c) Cholesterol test: This test is very important because it detects high cholesterol and triglyceride levels in a patient’s blood.

The coverage ratio for the creatinine test was 32%, while those

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The Botswana Medical Aid Funds ANNUAL REPORT 2019

for the ECG and Cholesterol tests were 10.5% and 25.8%, respectively, in 2019. The coverage ratios are again suboptimal, yet hospitalisation increased. It could be a function of member growth in 2019.

Human immunodeficiency virus HIV is spread through direct exposure to bodily fluids; it attacks the body’s immune system, specifically the CD4 cells. HIV was the most prevalent condition in both 2018

and 2019. In 2018 and 2019, the number of HIV patients was 12 335 and 12 969, respectively.

This equates to a 5.1% increase.

The coverage ratios for HIV conditions are shown in Table 7.

Process and outcome indicators The minimum interventions in the care of HIV patients are listed below: a) Viral load: This test is used to monitor the patient’s response to antiretroviral therapy.

b) CD4 count: This test is a good indicator of the state of a patient’s immune system.

These coverage values are low, while hospital admissions remained relatively unchanged in 2019 compared to 2018.

The coverage of HIV monitoring tests decreased slightly from 2018 to 2019. These ratios were 29.4% for the viral load test and 14.7% for the CD4 test in 2019.

In 2018, the coverage ratios were 30.2% and 15.5%, respectively.

Cardiovascular Disease

2018

2019

% change

Number of chronic beneficiaries

7 952

9 126

14.8%

Receiving at least one creatinine/eGFR test

31.8%

32.0%

0.6%

Receiving at least one electrocardiogram

10.6%

10.5%

-1.2%

Receiving at least one cholesterol test

25.8%

25.8%

-0.1%

13.4%

13.4%

0.2%

2018

2019

% change

12 335

12 969

5.1%

Receiving a viral load test at least once

30.2%

29.4%

-2.4%

Receiving a CD4 count test at least once

15.5%

14.7%

-4.9%

10.7%

10.7%

0.4%

Process indicator: Proportion of unique beneficiaries

Outcome indicator: Proportion of unique beneficiaries Admitted to hospital at least once Table 6: Cardiovascular disease coverage ratios

HIV Number of chronic beneficiaries Process indicator: Proportion of unique beneficiaries

Outcome indicator: Proportion of unique beneficiaries Admitted to hospital at least once Table 7: HIV coverage ratios

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ANNUAL REPORT 2019 The Botswana Medical Aid Funds

Medical aid funds’ Healthcare Expenditure Healthcare expenditure is the largest expense for medical aid funds.

It is important to monitor this expenditure to ensure efficiency and sustainability. This section’s expenditure figures are slightly different from those in the financial statement, mainly due to the fact that it takes into account treatment items; such as ‘claims incurred but not reported’ used in the financials.

Figure 8 depicts the proportions of expenditure paid to various healthcare providers for the period 2018-2019. In 2019, the bulk of expenditure went to Healthcare Service Providers (HSPs); they

received 43% of total expenditure, while hospitals received 27%. In comparison, expenditure on medicines and devices outside hospital accounted for 29% of total expenditure in 2019.

Expenditure at HSPs was P627 million in 2018, increasing to P691 million in 2019, a 10% increase year on year. Expenditure on medicines and devices dispensed outside hospitals increased by 8% from P430 million in 2018 to P466 million in 2019. Healthcare expenditure at hospitals increased by 0.2% to P435.5 million in 2019 from P434.7 million in 2018.

Figure 9 shows the total healthcare expenditure across beneficiaries by age band. The line graphs in the same figure represent the number of beneficiaries over age. Healthcare expenditure is lower in younger beneficiaries aged up to 29, though the number of beneficiaries is higher.

Among the older age bands, from 35 years onwards, expenditure is high while the number of beneficiaries increases. This form of cross-subsidisation is supported.

A positive observation one can make from Figure 9 is that the number of beneficiaries is increas-

2018

2019 1%

1% Hospitals

29%

28%

HSP

27%

29%

Medicines / Devices

Other 42%

43%

Figure 8: Healthcare expenditure in 2018 and 2019

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The Botswana Medical Aid Funds ANNUAL REPORT 2019

In 2019, medical aid funds spent on average P411 pbpm, an increase of 1.2% from P406 pbpm

Expenditure (P millions)

HE_2018

in 2018. Figure 10 shows that for age bands below the two horizontal lines (average expenditure in 2018 and 2019), beneficiaries are contributing positively to cross-subsidisation. In age bands above the average expenditure, beneficiaries benefit from cross-subsidisation.

HE_2019

Hospital expenditure and utilisation Hospital expenditure accounted for 27% of total healthcare expenditure in 2019, down from 29% in 2018. The number of admissions fell from 244 per 1 000 beneficiaries in 2018 to 192 per

Ben_2018

250,00

Ben_2019 40 35

200,00

30 25

150,00

20 100,00

15 10

50,00

5

0,00

-

Figure 9: Healthcare expenditure by age band HE_pbpm_2018

HE_pbpm_2019

Ave_HE_pbpm_2018

Expenditure pbpm (P)

3000 2500 2000 1500 1000 500 0

Figure 10: Average healthcare expenditure by age band

PREPARED BY The BOARD OF HEALTHCARE FUNDERS NPC

Ave_HE_pbpm_2019

No of beneficiaries (thousands)

ing across all age bands. Figure 10 depicts the principle of cross-subsidisation better. It shows medical aid funds’ expenditure by age band on a pbpm basis.

21

ANNUAL REPORT 2019 The Botswana Medical Aid Funds

The rates of admission are highest in older beneficiaries, who tend to be admitted more frequently and whose cost per admission is higher too. It is important for medical aid fund benefits to target interventions that reduce hospital admissions in the elderly, e.g. flu vaccines, disease management and

outpatient quality improvement.

Figure 12 illustrates admission rates and the average length of stay per day for hospital admissions. The graph indicates a strong correlation between the admission rate and average length of stay in hospital. In age bands

3000

12000

2500

10000

2000

8000

1500

6000

1000

4000

500

2000

0

0

Admissions per 1 000 Ben - 2018

Admissions per 1 000 Ben - 2019

Cost per Admission - 2018

Cost per Admission - 2019

Average cost per admission

Admissions per 1 000 beneficiaries

1 000 beneficiaries in 2019. Similarly, the average length of stay decreased from 3.12 days per admission in 2018 to 3.04 in 2019.

The average cost per admission was P4 633 in 2019, up from P4 006 in 2018. Figure 11 illustrates the average cost of admission and number of admissions over age.

Figure 11: Hospital admissions – average expenditure and number of admissions

8,0 7,0

2 500

6,0 2 000

5,0 4,0

1 500

3,0

1 000

2,0 500

1,0 -

-

Admissions per 1 000 Ben - 2018 Ave Length of Stay - 2018

Average Length of stay

Admissions per 1 000 beneficiaries

3 000

Admissions per 1 000 Ben - 2019 Ave Length of Stay - 2019

Figure 12: Hospital admissions – average length of stay and number of admissions

PREPARED BY The BOARD OF HEALTHCARE FUNDERS NPC

22

The Botswana Medical Aid Funds ANNUAL REPORT 2019

where admissions are high, the average length of stay is higher.

Health service professionals’ expenditure and utilisation The proportion of healthcare expenditure by medical aid funds to HSPs in 2018 and 2019 was 42% and 43%, respectively. In monetary terms this translates to a 10% increase in expenditure at HSPs. Figure 13 illustrates the healthcare expenditure by disciplines of practice in 2018 and 2019.

General practitioners received the largest portion of expenditure in 2019: 25%, which is equivalent to P169 million. This was followed by dentists and pathologists, with each receiving 16% of healthcare expenditure at HSPs. Medical and surgical specialists received 14%

1% 6% 24%

8%

Figure 14 shows the average expenditure per visit at HSPs in 2018 and 2019 by discipline. The average expenditure per visit at all HSPs increased by 6.4% to P365 in 2019, from P343 in 2018. The average expenditure per visit was highest for anaesthetists at P1 163 per visit in 2019. In 2018, average expenditure per visit was highest for dental specialists at P1 175.

12%

Allied professionals were the group with the second highest rate of utilisation at 1 060 visits per 1 000 beneficiaries in 2019.

Utilisation was lowest for anaesthetists, with 23 visits per 1 000 beneficiaries in 2019.

Figure 15 depicts utilisation per

2019

Dentists

2%

Pathology

6%

14%

1%

8%

Medical Specialists

Surgical Specialists

25%

12%

Radiology Dental Specialists

17%

Utilisation at general practitioners was highest compared to other disciplines; 2 668 per 1 000 beneficiaries in 2019, up from 2 611 per 1 000 beneficiaries in 2018, an increase of 2.2%. Visits to dental specialist were very low, accounting for only 44 per 1 000 beneficiaries in 2019. This is both a utilisation and quality measure.

General practitioners received the largest portion of HSP expenditure: 25%, while their average expenditure per visit was P197 in 2019. In 2018, the average expenditure at general practitioners was P188.

Supplementary and Allied Health Professionals

15%

1 000 beneficiaries in 2018 and 2019. Across all disciplines, utilisation decreased by 0.1% year on year. Utilisation was 5 847 per 1000 beneficiaries in 2019, down from 5 853 per 1 000 beneficiaries in 2018.

General Practitioners

2018 3%

and 8% of healthcare expenditure, respectively. Similar trends in expenditure were observed in 2018.

Anaesthetists

Figure 13: Healthcare expenditure at HSPs by discipline

PREPARED BY The BOARD OF HEALTHCARE FUNDERS NPC

16% 14% 16%

23

ANNUAL REPORT 2019 The Botswana Medical Aid Funds

2019 Average exp

2018 Average exp 1163 1131 1155 1175

Anaesthetists Dental Specialists 742 690

Radiology 494 478

Surgical Specialists 241 212

Supplementary and Allied…

429 406

Medical Specialists

690 653

Pathology

1009 1036

Dentists 197 188

General Practitioners -

200

400

600

800

1 000

1 200

1 400

Expenditure per visit (P)

Figure 14: Healthcare expenditure per HSP visit

2019 Visits per 1000 Ben Anaesthetists

23 22

Dental Specialists

44 43

2018 Visits per 1000 Ben

162 164

Radiology

341 347

Surgical Specialists

1060 1137

Supplementary and Allied…

715 745

Medical Specialists 501 510

Pathology 334 274

Dentists

2668 2611

General Practitioners -

500

1 000

1 500

2 000

2 500

3 000

Visits per 1 000 beneficiaries

Figure 15: Utilisation at health service professionals

PREPARED BY The BOARD OF HEALTHCARE FUNDERS NPC

24

The Botswana Medical Aid Funds ANNUAL REPORT 2019

Out-of-pocket EXPENDITURE Out-of-pocket (OOP) expenditure is the money individuals use to pay directly for health services when they access care. For medical aid beneficiaries, the level of OOP expenditure represents a gap between their healthcare expenditure and what medical aid funds pay on their behalf. It is probably an underestimate as it is based only on received claims – if a beneficiary pays OOP and does not submit a claim, that expenditure is not included in this calculation.

not exceed 15% of total healthcare expenditure by individuals.

The total amount claimed for health services in 2019 was P2.02 billion, while the total benefit paid was P1.61 billion. OOP expenditure was at least P403 million, representing at least 20% of total healthcare expenditure. In 2018, OOP expenditure was P355 million, representing 19% of total healthcare expenditure.

Out-of-pocket expenditure by age

The World Health Organisation recommends that OOP expenditure

Table 8 shows the level of OOP in 2018 and 2019. Most OOP expenditure was at Healthcare Service Providers (HSPs) and amounted to P167 million in 2019. This was followed by medicines and devices outside hospital, amounting to P116 million. OOP was lower at hospitals – P111 million in 2019, translating to 20% of all healthcare expenditure at hospitals.

Figure 16 shows OOP expenditure by age on a per beneficiary and per annum basis in 2018 and 2019. It increases with increasing age. For child dependents the levels of OOP are very low in nominal terms, however as a proportion of total healthcare expenditure it is consistent with other ages. The low OOP expenditure is therefore largely driven

by the claiming behaviour for child dependents, rather than the benefits on offer.

OOP expenditure among older ages was as high as P7 000 per beneficiary per annum in 2019.

This amount translates to about 100% of the average annual contribution for medical aid fund membership (adult contributions). Older beneficiaries need more protection from OOP expenditure.

Out-of-pocket expenditure at HSPs OOP expenditure was highest at HSPs in 2019, compared to hospitals and OOP expenditure for medicines and devices. The bulk of this went to pathologists, medical specialists and general practitioners.

Of the P167 million spent at HSPs, 30% was spent at both medical and surgical specialists. Figure 17 shows more detail on the level of OOP expenditure by discipline.

OOP Expenditure

OOP %

Financial Year

2018

2019

2018

2019

Hospitals

77.60

110.72

15%

20%

Healthcare service professionals

157.02

166.78

20%

19%

Medicines / devices

114.32

115.90

21%

20%

5.75

9.13

26%

30%

354.68

402.53

19%

20%

Other benefits Total Table 8: Out-of-pocket payments

PREPARED BY The BOARD OF HEALTHCARE FUNDERS NPC

25

ANNUAL REPORT 2019 The Botswana Medical Aid Funds

Out-of-Pocket Expenditure OOP payments (P millions)

9 000

30%

8 000

25%

7 000 6 000

20%

5 000

15%

4 000 3 000

10%

2 000

5%

1 000 -

0%

2018-OOP pbpa

2019-OOP pbpa

2018-OOP%

2019-OOP%

Figure 16: Out-of-pocket expenditure by age

2018 3%

Dentists

2%

3%

Pathology 14%

10%

4%

4%

20% 25%

Supplementary and Allied Health Professionals Surgical Specialists

2% 14%

Medical Specialists 8%

15%

2019

General Practitioners

11% 11% 11%

Radiology Dental Specialists

24% 19%

Anaesthetists

Figure 17: Out-of-pocket expenditure at HSPs PREPARED BY The BOARD OF HEALTHCARE FUNDERS NPC

26

The Botswana Medical Aid Funds ANNUAL REPORT 2019

Medical aid funds’ financial performance The funds showed a healthy financial performance in both 2018 and 2019. Gross contribution income grew by 9.2% from P1.76 billion in 2018 to P1.92 billion in 2019. During the same period, healthcare expenditure increased from P1.50 billion to P1.64 billion, an increase of 9.4%. The increase in contributions and healthcare expenditure was attributable to both annual increase adjustments due to inflationary factors, as well as growth in membership.

Comprehensive income On a pbpm basis, gross contributions grew by 3.2% from P475 to P490 from 2018 to 2019. Beneficiaries faced increases of 0.35% in excess of inflation. Annual inflation as measured by the consumer price index was 2.85% from 2018 to 2019. Healthcare expenditure grew at a slightly higher rate than gross contributions, 3.4% from

2018 to 2019 on a pbpm basis.

Healthcare expenditure was P404 pbpm in 2018 and increased to P418 pbpm in 2019.

Non-healthcare expenditure represents operational expenditure required to provide services. Lower non-healthcare expenditure while meeting deliverables is an indicator of operational efficiencies. Non-healthcare expenditure was 11.0% of gross contributions in 2019, i.e. P54 pbpm. In 2018, non-healthcare expenditure was P63 pbpm, representing 13.2% of gross contributions. Non-healthcare expenditure declined both in monetary terms and as a proportion of gross contribution income from 2018 to 2019. This is a positive as funds consequently have more financial resources available for healthcare expenditure.

gross contributions and expenditure, was positive for both 2018 and 2019. It was P31.1 million in 2018 and P71.6 million in 2019.

During the same period, the funds’ investments were also positive, contributing to a surplus in both years. This financial performance is summarised in Table 9.

Financial position In 2019, medical aid funds’ reserves increased by 11.4%, from P892 million in 2018 to P991 million. On a pbpm basis, this translates to a growth of 5.2%, increasing from P240 pbpm in 2018 to P253 pbpm in 2019. This level of growth in reserves is very positive as growth in membership is often associated with a decline in reserves.

The net healthcare result, calculated as the difference between

The funds are in a very strong financial position; the reserves translated to a solvency level of 51.6% of gross contribution income in 2019.

Million Pula

Pula pbpm

2018

2019

% Change

2018

2019

% Change

Gross contributions

1 763.0

1 924.5

9.2%

474.7

489.7

3.2%

Healthcare expenditure

1 499.9

1 641.3

9.4%

403.8

417.6

3.4%

232.0

211.6

-8.8%

62.5

53.8

-13.8%

Net healthcare result

31.1

71.6

130.4%

8.4

18.2

117.8%

Other income

33.7

46.2

37.1%

9.1

11.8

29.6%

Comprehensive income

64.8

117.8

81.9%

17.4

30.0

71.9%

Non-healthcare expenditure

Table 9: Statement of comprehensive income PREPARED BY The BOARD OF HEALTHCARE FUNDERS NPC

27

ANNUAL REPORT 2019 The Botswana Medical Aid Funds

ASSET A LLO C AT IO N Fixed Assets

Money Market

Bonds

Equity

99,37

Other Investments 174,88

146,40

173,64

109,77

101,16

332,35

329,36

203,87

214,01

2018

2019

Figure 18: Allocation of medical aid fund investments

Million Pula

Pula pbpm

2018

2019

% Change

2018

2019

% Change

Total investments

836.2

867.8

3.8%

225.1

220.8

-1.9%

Current assets

241.3

344.1

42.6%

65.0

87.6

34.8%

-185.7

-218.8

17.8%

-50.0

-55.7

11.3%

891.8

993.0

11.4%

240.1

252.7

5.2%

Current liabilities Reserves available for funds

Table 10: Statement of financial position There was a strengthening in the solvency level; it increased by 100 basis points from 50.6% in 2018.

The financial position of the funds is summarised in Table 10.

Allocation of reserves In 2019, a significant portion of the reserves was invested in money market instruments – 33%: these are secure investments that tend to provide returns below inflation. Bonds provide greater returns but are generally less secure as they are long-term investments. The funds had 10% of their reserves invested in bonds

at the end of 2019. Equity investments generally provide longterm returns in excess of inflation, but these are risky investments.

The funds’ exposure to equity investments was 17% as at 31 December 2019. Figure 18 provides more descriptive asset allocation as at the end of 2018 and 2019.

Medical aid funds generally have short-term liabilities and require exposure to investment that can be liquidated easily – suggesting that money market investments are suitable. However, contributions often increase at rates above inflation; likewise invest-

ment returns should increase above inflation so that beneficiaries are protected from the higher contribution increases necessary to maintain reserves.

Medical aid funds are therefore faced with a delicate balance: the need to ensure reserves are secure and yet provide long-term investment returns often greater than inflation. In line with international standards, medical aid funds are encouraged to manage their reserves on a risk-based capital basis, which allows funds to use reserves in a more efficient way.

PREPARED BY The BOARD OF HEALTHCARE FUNDERS NPC

28

The Botswana Medical Aid Funds ANNUAL REPORT 2019

ANNEXURES and References ANNEXURE A Medical aid fund beneficiaries Financial year

2018

2019

Age Band

Male

Female

Total

Male

Female

Total

Less than one year

2 188

2 193

4 381

2 157

2 017

4 174

1-4 years

12 867

12 529

25 396

13 300

12 990

26 290

5-9 years

18 144

17 853

35 997

18 865

18 890

37 755

10-14 years

15 743

15 345

31 088

16 844

16 343

33 187

15-19 years

13 094

12 882

25 976

13 778

13 683

27 461

20-24 years

3 747

4 194

7 941

5 642

6 118

11 760

25-29 years

5 140

7 657

12 797

5 185

7 986

13 171

30-34 years

10 814

14 873

25 687

10 567

14 679

25 246

35-39 years

15 137

18 959

34 096

15 510

19 857

35 367

40-44 years

15 191

16 415

31 606

15 596

17 215

32 811

45-49 years

12 711

12 933

25 644

13 505

13 675

27 180

50-54 years

9 480

9 860

19 340

10 216

10 478

20 694

55-59 years

6 367

6 781

13 148

6 878

7 281

14 159

60-64 years

4 041

4 068

8 109

4 335

4 433

8 768

65-69 years

2 113

2 099

4 212

2 404

2 433

4 837

70-74 years

1 185

1 090

2 275

1 359

1 244

2 603

75-79 years

578

510

1 088

635

562

1 197

80-84 years

237

253

490

282

278

560

85 years+

104

131

235

119

144

263

148 881

160 625

309 506

157 177

170 306

327 483

Total

PREPARED BY The BOARD OF HEALTHCARE FUNDERS NPC

29

ANNUAL REPORT 2019 The Botswana Medical Aid Funds

ANNEXURE B Consolidated financial statements Pula millions

Pula pbpm

2018

2019

% Change

2018

2019

% Change

1 762.99

1 924.47

9%

474.68

489.71

3.2%

-

-

-

-

-

-

Net contribution income

1 762.99

1 924.47

9%

474.68

489.71

3%

Relevant healthcare expenditure

1 499.88

1 641.26

9%

403.84

417.64

3%

Net claims incurred

1 495.82

1 636.09

9%

402.74

416.33

3%

4.07

5.17

27%

1.09

1.31

20%

Gross healthcare result

263.10

283.21

8%

70.84

72.07

2%

Net non-healthcare expenditure

232.01

211.57

-9%

62.47

53.84

-14%

12.86

12.81

0%

3.46

3.26

-6%

1.23

1.35

-

0.33

0.34

4%

211.11

191.29

10%

56.84

48.68

-14%

Net impairment losses: trade and other receivables

6.81

6.11

-10%

1.83

1.55

-15%

Net healthcare result

31.09

71.64

130%

8.37

18.23

118%

Net impairment losses: other

-3.84

-1.73

-55%

-1.03

-0.44

-57%

Other investment income

29.47

42.45

44%

7.94

10.80

36%

Realised and unrealised gains/losses

16.28

6.43

-61%

4.38

1.64

-63%

1.39

0.67

-52%

0.37

0.17

-54%

Other expenditure

-2.01

-2.83

41%

-0.54

-0.72

33%

Finance costs

-3.38

-3.38

0%

-0.91

-0.86

-6%

Net surplus for the year

69.01

113.25

64%

18.58

28.82

55%

Other comprehensive income

-4.24

4.58

-208%

-1.14

1.16

-202%

Fair value adjustment on available-for-sale investments

-4.34

4.49

-203%

-1.17

1.14

-198%

0.10

-

-100%

0.03

-

-100%

-

0.09

0%

-

0.02

0%

64.77

117.82

82%

17.44

29.98

72%

Calendar Year Gross contribution income Savings contribution income

Accredited managed healthcare services (no transfer of risk)

Net income/(expenses) on commercial reinsurance Broker costs Administrator expenditure

Other income

Reclassification adjustment Other Total comprehensive income for the year

PREPARED BY The BOARD OF HEALTHCARE FUNDERS NPC

30

The Botswana Medical Aid Funds ANNUAL REPORT 2019

ANNEXURES and References LIST A List of Figures Figure 1: Medical aid fund beneficiaries.............................................................................................. 10 Figure 2: Benefit option sizes................................................................................................................ 11 Figure 3: Number of beneficiaries by age band.................................................................................. 12 Figure 4: Chronic disease prevalence................................................................................................... 13 Figure 5: New chronic beneficiaries registered................................................................................... 14 Figure 6: Chronic disease prevalence by age band in 2018.............................................................. 15 Figure 7: Chronic disease prevalence by age band in 2019.............................................................. 15 Figure 8: Healthcare expenditure in 2018 and 2019......................................................................... 19 Figure 9: Healthcare expenditure by age band................................................................................... 20 Figure 10: Average healthcare expenditure by age band................................................................... 20 Figure 11: Hospital admissions – average expenditure and number of admissions....................... 21 Figure 12: Hospital admissions – average length of stay and number of admissions.................... 21 Figure 13: Healthcare expenditure at HSPs by discipline.................................................................. 22 Figure 14: Healthcare expenditure per HSP visit................................................................................ 23 Figure 15: Utilisation at health service professionals......................................................................... 23 Figure 16: Out-of-pocket expenditure by age..................................................................................... 25 Figure 17: Out-of-pocket expenditure at HSPs................................................................................... 25 Figure 18: Allocation of medical aid fund investments...................................................................... 27

PREPARED BY The BOARD OF HEALTHCARE FUNDERS NPC

ANNUAL REPORT 2019 The Botswana Medical Aid Funds

31

LIST B List of Tables Table 1: Summary of benefit options in 2018 and 2019................................................................... 11 Table 2: Number of beneficiaries by dependent type........................................................................ 11 Table 3: Average age and pensioner ratios........................................................................................... 12 Table 4: Diabetes coverage ratios......................................................................................................... 16 Table 5: Respiratory diseases coverage ratios..................................................................................... 17 Table 6: Cardiovascular disease coverage ratios................................................................................. 18 Table 7: HIV coverage ratios.................................................................................................................. 18 Table 8: Out-of-pocket payments.......................................................................................................... 24 Table 9: Statement of comprehensive income..................................................................................... 26 Table 10: Statement of financial position............................................................................................. 28

LIST C List of Acronyms and Abbreviations BHF...............Board of Healthcare Funders CVS...............Cardiovascular DM................Diabetes mellitus FWA..............Fraud, waste and abuse HIV................Human immunodeficiency virus HSP...............Healthcare service provider NBFIRA.........Non-Banking Financial Institutions Regulatory Authority OOP..............Out-of-pocket Pbpm.............Per beneficiary per month PCNS............Practice Code Numbering System SADC............Southern African Development Community UHC..............Universal healthcare coverage WHO............World Health Organisation

PREPARED BY The BOARD OF HEALTHCARE FUNDERS NPC

32

The Botswana Medical Aid Funds ANNUAL REPORT 2019

CONTACT INFORMATION Board of Healthcare Funders Serving Medical Scheme Members REGISTERED OFFICE Lower Ground Floor, South Tower, 1Sixty Jan Smuts Jan Smuts Avenue Cnr Tyrwhitt Avenue Rosebank, 2196

CONTACT DETAILS Tel: +27 11 537 0200 Fax: +27 11 880 8798 Client Services: 0861 30 20 10 E-mail: marketing@bhfglobal.com Web: www.bhfglobal.com

COMPANY REGISTRATION NUMBER 2001/003387/08

PREPARED BY The BOARD OF HEALTHCARE FUNDERS NPC

Lobby and advocate policy position on behalf of our members Assist members with regulatory compliance Provide legal advice to membership on industry issues Assist in containing healthcare costs Protect the image of the industry Identify and monitor trends impacting our members

2. Create Platforms for Member Engagement

2

Promote unity and collaboration by creating platforms that enable our members to engage with the BHF and participate in industry issues Create networking opportunities Engage and develop relationships with key stakeholders

3

3. Develop Industry Standards

1

s

n o i it

P e r op u l a o V

1. Represent Member Interests

Promote best practice in the healthcare funding industry Promote healthcare quality Identify and recognise key role players in the industry

4

4. Facilitate Education and Training Provide guidance Provide stewardship and facilitate thought leadership exchange on industry issues Enhance skills and knowledge within our membership Progress tracking reports on industry issues Promote stakeholder, consumer awareness and medical scheme member education

5 6 5. Transformation through Development Identify opportunities to drive transformation in the industry Graduate programme development

Provide and Identify Opportunities Profile our members and our industry

Board of Healthcare Funders Serving Medical Scheme Members Tel: +27 11 537 0200 Fax: +27 11 880 8798 Client Services: 0861 30 20 10 E-mail: marketing@bhfglobal.com Web: www.bhfglobal.com

ANNUAL REPORT

2019

The Botswana Medical Aid Funds