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
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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
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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.
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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
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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
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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
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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
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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
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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
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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.
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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
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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
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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
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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
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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
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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
