Dear General Practitioner,
SAMWUMED has three main goals.
- To ensure that our members have benefits to access private healthcare.
- To ensure that benefits assist our members to maintain or improve their health.
- To ensure that membership of SAMWUMED remains affordable.
SAMWUMED, like most medical aid schemes in South Africa, is facing financial challenges due to increasing healthcare expenditure. This has resulted in contribution increases over 10% across the industry in the last few years.
To ensure that SAMWUMED remains financially stable, and members maximize their available benefits, the Board has decided to implement a coordination of care strategy. Co-ordination of care has been shown to improve clinical “outcomes”, and is essential to improving universal access to care, and is a key component of the planned NHI system.
SAMWUMED’s strategy has the following components:
- All members must nominate a GP to co-ordinate their care.
- Preferably the nominated GP should be contracted to the SAMWUMED GP Network so that members do not experience co-payments. We strongly request that you consider joining the SAMWUMED GP network.
- SAMWUMED is contracting a Designated Service Provider (DSP) Specialist Network for 2024 that is affiliated with our Hospital Network.
- Members must be referred by their chosen GP to a Specialist, ideally a Network Specialist, or Allied Health Professional for their claims to be funded.
SAMWUMED will be closely monitoring the implementation of this strategy and using the REPI2 Medscheme tool to enhance the remuneration of Network GPs who demonstrate excellent clinical outcomes.
Your patients may express concern about not being able to go directly to Specialists but a diagnostic work-up, facilitated through consultation with a GP, is required for effective specialist treatment. It is important to ensure that patients are referred to the right specialist, preferably one who is contracted to the SAMWUMED Specialist network and can be treated in a Network Hospital to ensure that our members don’t have co-payments.
In cases where members have a medical emergency, they must be referred to the closest appropriate medical facility to ensure they receive the care they need.
We look forward to working with you embracing the strategy of Co-ordination of care, to ensure that SAMWUMED becomes a healthier and more financially stable Scheme.
Yours in good health