Prevalence of chronic diseases in the population covered by medical aid schemes in South Africa

Transcription

1 Prevalence of chronic diseases in the population covered by medical aid schemes in South Africa Research and Monitoring Unit June 2014 Chairperson: Prof. Y Veriava Chief Executive & Registrar: Dr M Gantsho Block A, Eco Glades 2 Office Park, 420 Witch-Hazel Avenue, Eco Park, Centurion, 0157 Tel: Fax: Customer Care: Information@medicalschemes.com

2 Contents Acknowledgements... 1 Executive Summary Introduction Research approach Purpose Data source Analytical approach Results Scheme demographics CDL prevalence Hypertension Hyperlipidaemia Diabetes mellitus type Asthma Hypothyroidism HIV/AIDS Ischaemic heart disease Epilepsy Cardiomyopathy Dysrhythmias Other CDL conditions Top 10 CDL conditions: Multiple CDL conditions: Top 10 CDL conditions by scheme size: Discussion References Chairperson: Prof. Y Veriava Chief Executive & Registrar: Dr M Gantsho Block A, Eco Glades 2 Office Park, 420 Witch-Hazel Avenue, Eco Park, Centurion, 0157 Tel: Fax: Customer Care: Information@medicalschemes.com

3 Acknowledgements The research team responsible for this work was led by Mr. Mondi Govuzela and Mrs. Carrie-Anne Cairncross, researchers of the Research and Monitoring Unit, at the Council for Medical Schemes (CMS). We also acknowledge the contributions made to the development of these ideas by Mr. Michael Willie, and Dr. Anton de Villiers. 1

4 Executive Summary The 2014 retrospective study of the CMS s Scheme Risk Measurement Database was undertaken to establish changes in the frequency of chronic diseases among beneficiaries of medical schemes between 2011 and The study compared trends for open and restricted schemes, schemes of various sizes, and a range of benefit options. The main finding was that there has been a sustained upward trend in diagnosis and treatment of many conditions on the chronic disease list (CDL). While the study could not isolate specific reasons for this increase in chronic diseases, the trend could be generally attributed to improved data management systems of medical schemes and administrators, the deteriorating disease profile and higher average age of beneficiaries, increased beneficiary awareness of entitlements and changes in care-seeking behaviour. The findings of the 2014 prevalence study are summarised in Table 1 below. Table 1: Prevalence of chronic conditions (Cases/1 000 beneficiaries), 2011 and 2012 Condition Type Trends Hypertension (HYP) Hyperlipidaemia (HYL) Diabetes mellitus type 2 (DM2) Total Overall increase of approximately 4% between Open and 2012, with increase more marked in Restricted restricted schemes (8%) than open schemes (2%) Total Moderate increase across all schemes, with higher Open prevalence in open schemes Restricted Total Overall increase of almost 10% across all Open Restricted schemes. Both prevalence and rate of increase were slightly higher in restricted schemes Asthma (AST) Total Moderate increase across all schemes and similar Open prevalence rates in open and restricted schemes Restricted Hyperthyroidism (TDH) HIV/AIDS (Receiving ARVs) Ischaemic heart disease (IHD) Epilepsy (EPL) Total Overall increase of 3% across all schemes. In Open restricted schemes the increase was 7% while Restricted open schemes showed no significant increase Total Largest increase of any condition, with 55% rise in Open Restricted prevalence across all schemes. Prevalence and rate of increase were higher in restricted schemes Total Prevalence across the total number of schemes Open remained steady with higher prevalence in open Restricted schemes and a minor rise in restricted schemes Total No significant increase and prevalence rate of Open about 4 per beneficiaries remained steady 2

5 Cardiomyopathy (CMY & CHF) Dysrhythmias (DYS) Restricted across all types of schemes Total Minor increases appear insignificant and similar Open prevalence occurs in all categories of schemes Restricted Total Overall increase of 5% between 2011 and 2012 Open across all schemes, with higher prevalence in open Restricted schemes Figure 1 below depicts the trends in the top 10 common conditions between 2007 and The order of these conditions has remained mostly unchanged for the period under review. Hypertension, hyperlipidaemia and diabetes mellitus type 2 have shown the fastest increase amongst the top 10 common diagnosed and treated CDL conditions. Other conditions, though increasing, have remained at rates below twenty per thousand beneficiaries. Figure 1: Top 10 diagnosed and treated CDL conditions: Figure below shows the pace of increase in the diagnosis and treatment of some of the chronic conditions. The number of beneficiaries on ARV/HAART treatment has increased by 195% between 2007 and This may be attributable to reducing stigma related to HIV and AIDS. The number of beneficiaries treated for bipolar mood disorder increased by 173% in the period under review. CDL conditions that may be attributable to lifestyle choices such as diabetes mellitus type 2 (78%), 3

6 cardiomyopathy (58%) and hypertension (41%), have also shown a strong and sustained increase for period between 2007 and Figure 2: Top 10 fastest increasing treated conditions:

7 1 Introduction The Medical Schemes Act of 1998 makes it mandatory for medical schemes to cover costs for the diagnosis, treatment or care of a defined set of benefits or Prescribed Minimum Benefits (PMBs), regardless of the benefit option they have selected. PMBs include any medical condition which meets the definition of an emergency, a limited set of 270 medical conditions and 25 chronic conditions defined in the Chronic Disease Listing (CDL). CDL specifies medication and treatment for the chronic conditions that are covered as PMBs. This law ensures that beneficiaries with chronic conditions are not risk-rated and forced to pay higher amounts for their cover. Various factors were taken into account when identifying the chronic diseases that would be covered, such as; the nature of the disease and how that disease would affect the quality of life of the individual, the prevalence of the conditions the affordability of the treatment, and the financial impact to medical schemes. The 2013 retrospective study of the Scheme Risk Measurement database of the Council for Medical Schemes for the period found that there had been a sustained upward trend in diagnosis and treatment of many chronic conditions on the CDL. These increases were thought to be as a result to improved data management systems of medical schemes and administrators, the worsening age and disease profile of beneficiaries, the increased beneficiary awareness of entitlements, and behavioural change. Unfortunately, the study could not isolate the different components that contribute to the observed trends. The study found that the top ten conditions that showed the most rapid increase in the period , in order of their prevalence from highest to lowest in 2011 were hypertension, hyperlipidaemia, diabetes mellitus type 2, hypothyroidism, glaucoma, rheumatoid arthritis, bipolar mood disorder, Parkinson s disease, chronic renal disease, and systemic lupus erythematosus. The prevalence of hypertension grew by 36.8% between 2006 and 2011, from 57.6 to 78.8 per beneficiaries, making it the fastest increasing cardiovascular disease among medical scheme beneficiaries and the most prevalent chronic disease on the PMB Chronic Disease List (CDL). Hyperlipidaemia s prevalence among beneficiaries grew by 37.7% from 23.9 in beneficiaries in 2006 to 32.9 in beneficiaries in This is most likely due to lifestyle changes. The 84.2% increase in the prevalence of diabetes mellitus type 2 between 2006 and 2011 (from 12.0 to 22.1 per 1000) again points to the importance of leading a healthy lifestyle. 5

8 Six times more females were treated for hypothyroidism between 2006 and 2011 than male beneficiaries. The overall prevalence of the disease increased from 9.7 to 13.7 per beneficiaries in that period. The prevalence in female beneficiaries increased by 37.5%, from 16.5 per in 2006 to 22.6 per in The prevalence of hypothyroidism among male beneficiaries increased at a faster rate, from 2.3 per in 2006 to 3.8 per in 2011, an increase of 63.2%. The prevalence of glaucoma increased from 1.8 per beneficiaries in 2006 to 2.7 per in The study found that there was no significant gender-related difference in prevalence. Rheumatoid arthritis prevalence increased from 2.0 per beneficiaries in 2006 to 2.6 per beneficiaries in 2011, an increase of 31.7%. More female beneficiaries were treated for the disease during that period than male. The prevalence of rheumatoid arthritis amongst female beneficiaries increased from 2.8 to 3.8 per in , compared to a change from 1.1 to 1.4 per in male beneficiaries during the same period. The prevalence of bipolar mood disorder (BMD) among medical schemes beneficiaries more than doubled between 2006 and The psychiatric condition showed an increase of a staggering 250.0% during the period covered by the study. Very few beneficiaries under the age of 14 years were treated for BMD, but the prevalence of BMD among female beneficiaries years increased from 1.0 per in 2006 to 2.9 per in Similar trends were observed in the older age groups (above 40 years). Parkinson s disease prevalence increased by 47.2% between 2006 and 2011, from 0.5 to 0.8 per beneficiaries. Prevalence of the disease among beneficiaries between the ages of 60 and 79 years increased from 3.9 to 4.4 per in the same period; the prevalence was higher in beneficiaries older than 80 years, increasing from 11.0 per in 2006 to 12.2 per 1000 in The prevalence of chronic renal disease increased from 0.2 per in 2006 to 0.3 per beneficiaries in 2011, an increase of 47.6%. More male than female beneficiaries were treated for the disease, in 2011, its prevalence was 0.4 per male and 0.3 per female beneficiaries. The prevalence of systemic lupus erythematosus (SLE) increased from 0.16 per beneficiaries in 2006 to 0.22 per beneficiaries in The prevalence of SLE was higher in women than in men. There were seven times more women than men treated for SLE in

9 Chronic diseases remain a serious concern in South Africa. It is reported that 37% of deaths that occurred during 2000 in South Africa were due to chronic diseases. The WHO estimates that deaths from chronic diseases will increase by 77% by 2020, and that most of these deaths will occur in the developing regions of the world (WHO, 2011). The 2014 prevalence report presents the results of the retrospective review of the trends in the prevalence of chronic diseases in the medical schemes industry from 2007 to 2012, a follow-up to the 2013 prevalence report (CMS, 2013). 7

10 2 Research approach 2.1 Purpose This study evaluated trends in the frequency of chronic diseases (CDLs) in the medical schemes beneficiaries between 2007 and HIV/AIDS will also be included in the analysis because on the chronic nature of HAART treated HIV/AIDS. People infected with HIV/AIDS now have the same requirements as those of patients with traditional chronic diseases such as hypertension and asthma. The study compared these trends between open and restricted schemes, as well as on the size of the medical schemes. This study is a follow-up to the 2013 report on the retrospective review of the trends in the prevalence of chronic diseases in the medical schemes industry from 2006 to Data source This study relied on the data that is submitted by medical schemes for the purposes of Scheme Risk Measurement project (SRM). The SRM database contains aggregate prevalence data for more than 99% of all medical schemes beneficiaries. Medical schemes use the rules set out in the Guidelines for the Identification of Beneficiaries with Risk Factors in Accordance with the Entry and Verification Criteria (CMS, 2014) to identify each chronic disease case. The purpose of this guideline is to define criteria that must be met in the identification of beneficiaries with the all the CDL conditions, HIV and maternity events. These criteria have been developed with the emphasis on the verifiability of cases and are used to ensure that there is uniformity in the way that medical schemes identify SRM risk factors. These guidelines provide specific clinical codes that serve to identify patients who were treated for CDL conditions. 2.3 Analytical approach The data was extracted into Windows Excel spreadsheet format and imported to STATA statistical software package for management and analysis. The output was then transcribed to Excel for tabulating summary statistics and constructing graphical representation of the results. The average annual prevalence and number of lives for each age band were calculated for each medical scheme or chosen strata (scheme type or size). The 2014 study will report on the annual average prevalence based on the average annual beneficiaries. Prevalence for the month of June was reported in the 2013 report. The difference between these two approaches is not significant, but caution should be exercised when comparing the findings of the two reports. Only data that was deemed to be of acceptable quality 8

11 through the SRM data quality evaluation process was included in the analysis. The proportion of beneficiaries for whom fair data was submitted ranged from 75.0% to 84.0% during 2011 and Descriptive statistics were calculated to produce summary statistics of key variables. CDL s included in the analysis are listed in Table 2. Table 2: Chronic diseases in the Chronic Disease List Chronic Disease Code Full Description ADS Addison s Disease AST Asthma BCE Bronchiectasis BMD Bipolar Mood Disorder CHF Cardiac failure 1 CMY Cardiomyopathy COPD Chronic Obs. Pulmonary Disease CRF Chronic Renal Disease CSD Crohn s Disease DBI Diabetes Insipidus DM1 Diabetes Mellitus 1 DM2 Diabetes Mellitus 2 DYS Dysrhythmias EPL Epilepsy GLC Glaucoma HAE Haemophilia HYL Hyperlipidaemia HYP Hypertension IBD Ulcerative Colitis IHD Coronary Artery Disease MSS Multiple Sclerosis PAR Parkinson s Disease RHA Rheumatoid Arthritis SCZ Schizophrenia SLE Systemic Lupus Erythematosus TDH Hypothyroidism HIV/AIDS HIV/AIDS 1 CHF was combined with CMY in the prevalence tables. 9

12 3 Results 3.1 Scheme demographics Demographics of beneficiaries of medical schemes are shown in Table 3. The number of beneficiaries in all schemes increased by 1.8%, the average age increase from 31.6 to 32.0 and the pensioner ratio increased from 6.6% to 7.1% between 2011 and The number beneficiaries in restricted schemes grew by 4.1%. The average age and pensioner ratio increased by 1.4% and 11.8%, respectively. No significant change was observed in the number of beneficiaries in open medical schemes. The average age and pensioner ratio for open schemes increased by 1.5% and 5.1%, respectively. Table 3: Medical schemes demographics (all beneficiaries) Attribute Lives Average age Pensioner ratio (%) Restricted Open Total % change % change % change

13 3.2 CDL prevalence The 2011 and 2012 average prevalence per beneficiaries for the 26 CDL conditions in open and restricted schemes is shown in Table 4 below. Cardiomyopathy (CMY) and cardiac heart failure (CHF) are reported together as per SRM Entry and Verification criteria. Table 4: Average prevalence per beneficiaries for the 26 CDL conditions Chronic 2012 industry rank Restricted Open Total Disease Code (2011) % change % change % change ADS 24 (23) % % % AST 4 (4) % % % BCE 23 (23) % % % BMD 13 (14) % % % CMY & CHF 9 (8) % % % COP 15 (15) % % % CRF 18 (18) % % % CSD 21 (21) % % % DBI 25 (25) % % % DM1 14 (13) % % % DM2 3 (3) % % % DYS 10 (10) % % % EPL 8 (9) % % % GLC 12 (11) % % % HAE 25 (25) % % % HYL 2 (2) % % % HYP 1 (1) % % % IBD 19 (19) % % % IHD 7 (7) % % % MSS 22 (22) % % % PAR 16 (16) % % % RHA 11 (12) % % % SCZ 17 (17) % % % SLE 20 (20) % % % TDH 5 (5) % % % HIV 6 (6) % % % 11

14 Prevalence rate per beneficiaries The prevalence rank of many CDL conditions has remained unchanged between 2011 and The prevalence of rare CDL conditions such as addison s disease, bronchiectasis, crohn s disease, haemophilia, ulcerative colitis, multiple sclerosis, schizophrenia and systemic lupus erythematosus has shown very little change in the period under review. The large changes in prevalence were seen mostly in CDL conditions that are associated with lifestyle choices. These include diabetes mellitus type 2, hyperlipidaemia and hypertension. Asthma and HIV/AIDS make a significant contribution to the burden of disease in the medical schemes. Significant changes in CDL conditions are discussed in more detail in the next section Hypertension Hypertension (HYP) was the most diagnosed and treated condition in both 2011 and The prevalence of hypertension increased by 4% between 2011 and 2012 from to per thousand beneficiaries in all medical schemes. In 2011, the prevalence of hypertension was higher in open schemes than in restricted schemes. The prevalence in restricted schemes was while open schemes recorded a prevalence of per thousand beneficiaries. In 2012, the prevalence of hypertension in restricted schemes increased by 8% to per thousand beneficiaries. Prevalence in open schemes showed a moderate increase of 2% to per thousand beneficiaries in Figure 3 below shows HYP grew by 41.3% from per thousand beneficiaries in 2007 to per thousand beneficiaries in Figure 3: Average prevalence of hypertension between 2007 and Year Hypertension 12

15 Prevalence rate per beneficiaries Hyperlipidaemia Hyperlipidaemia (HYL) remained the second most prevalent condition in The average number of beneficiaries in the industry who were treated for hyperlipidaemia increased by 3%, from in 2011 to per thousand beneficiaries in Similar to hypertension, the prevalence of hyperlipidaemia was higher in open schemes than in restricted schemes. The prevalence in restricted schemes was while open schemes recorded a prevalence of per thousand beneficiaries in In 2012, the prevalence of hyperlipidaemia increased to and per thousand beneficiaries in restricted and open schemes. A steady increase in the overall prevalence of treated HYL was noted between 2007 and 2012 as shown in Figure 4. HYL increased from per thousand in 2007 to per thousand beneficiaries in 2012, an increase of 17.7%. Figure 4: Average prevalence of hyperlipidaemia between 2007 and Year Hyperlipidaemia 13

16 3.2.3 Diabetes mellitus type 2 Diabetes mellitus type 2 (DM2) was the third most prevalent CDL condition in 2011 and Across all medical schemes, the prevalence of DM2 increased by 10% from in 2011 to per thousand beneficiaries in More beneficiaries in restricted schemes were diagnosed and treated for DM2. In restricted schemes, the prevalence of DM2 increased by 11% from in 2011 to per thousand beneficiaries in In open schemes, prevalence increased by 8% from to per thousand beneficiaries for the period under review. Figure 5 shows that overall prevalence of DM2 has increased from per thousand in 2007, to per thousand in This represents an increase of 78% for the period of the study. Figure 5: Average prevalence of diabetes mellitus type 2 between 2007 and Prevalence rate per beneficiaries Year Diabetes Mellitus 2 14

17 3.2.4 Asthma Asthma (AST) was ranked as the fourth most diagnosed CDL condition in 2011 and The prevalence of asthma increased moderately from to per thousand beneficiaries in all medical schemes. In 2012, the average prevalence of asthma was similar in both open (15.77 per thousand beneficiaries) and restricted (15.78 per thousand beneficiaries) schemes. The increase in the prevalence of asthma was more significant when observed over a longer period. As shown in Figure 6, the overall prevalence of asthma in the medical aid population increased by 22% between 2007 and 2012, from to per thousand beneficiaries. Figure 6: Average prevalence of asthma between 2007 and Prevalence rate per beneficiaries Year Asthma 15

18 3.2.5 Hypothyroidism Hypothyroidism (TDH) was the fifth most prevalent condition in the period under review. The prevalence of hyperthyroidism increased by 3% from to per beneficiaries in all medical schemes. Hyperthyroidism was more prevalent in open schemes than restricted schemes. In restricted schemes, prevalence increased by 7% from to per thousand beneficiaries. For open schemes, the increase in the number of beneficiaries treated for hyperthyroidism did not show a significant increase between 2011 (15.23 per thousand beneficiaries) and 2012 (15.26 per thousand beneficiaries). The average prevalence of TDH increased from to per thousand beneficiaries for the period between 2007 and 2012, as shown in Figure 7. Figure 7: Average prevalence of hypothyroidism between 2007 and Prevalence rate per beneficiaries Year Hypothyroidism 16

19 Prevalence rate per beneficiaries HIV/AIDS The largest increase in prevalence of any condition was observed in HIV/AIDS. The average number of beneficiaries on ARV s increased by 55% from 9.38 in 2011 to per thousand beneficiaries. The prevalence of HIV/AIDS was higher in restricted schemes than in open schemes. In restricted schemes, prevalence increased from by 60% to per thousand beneficiaries, whilst the prevalence increased by 42% from 6.00 to 8.53 per thousand beneficiaries for open medical schemes as depicted in Table 4. Between 2007 and 2012, that average prevalence of HIV/AIDS increased by 195%, from 4.94 to per thousand beneficiaries as depicted in Figure 8. Figure 8: Average prevalence of HIV/AIDS between 2007 and Year HIV/AIDS 17

20 Prevalence rate per beneficiaries Ischaemic heart disease Ischaemic heart disease (IHD) was the seventh most prevalent condition in the period under review. The prevalence of ischaemic heart disease has remained steady at 7.30 per thousand beneficiaries in 2011 and 2012 for all medical schemes. The prevalence of this cardiovascular condition was higher in open schemes than in restricted schemes, even though a minor increase was observed in restricted schemes. In 2012, prevalence was 6.11 and 8.35 per thousand beneficiaries in restricted and open schemes, respectively. The average prevalence rate of IHD was 7.30 per thousand beneficiaries in 2012 compared to 6.44 per thousand beneficiaries in 2007 as depicted in Figure 9. The 2009 spike in the prevalence of IHD is likely to be attributable to the quality of submitted data. Figure 9: Average prevalence of ischaemic heart disease between 2007 and Year Coronary Artery Disease 18

21 3.2.8 Epilepsy Epilepsy (EPL) became the 8th most prevalent CDL condition in 2012, from position 9 in About four for every thousand beneficiaries across all schemes, irrespective of scheme type, were diagnosed and treated for epilepsy in 2011 and The prevalence of treated EPL increased by 22% from 3.48 per thousand beneficiaries in 2007, to 4.24 per thousand beneficiaries in 2012 as shown in Figure 10. Figure 10: Average prevalence of epilepsy between 2007 and Prevalence rate per beneficiaries Year Epilepsy 19

22 Prevalence rate per beneficiaries Cardiomyopathy About four in every thousand beneficiaries across all schemes, irrespective of scheme type, were diagnosed and treated for cardiomyopathy and cardiac heart failure (CMY & CHF) in 2011 and The observed increases in the prevalence do not seem to be significant. As shown in Figure 11, the prevalence of diagnosis and treatment of CMY paid for by medical aid schemes increased from 2.65 per 1000 in 2007, to 4.17 per 1000 in The 2009 spike in the prevalence of IHD is likely to be attributable to the quality of submitted data. Figure 11: Average prevalence of cardiomyopathy between 2007 and Year Cardiomyopathy 20

23 Dysrhythmias Dysrhythmias (DYS) completes the list of top ten most prevalent conditions in The average number of beneficiaries diagnosed with DYS increased by 5% from 3.43 in 2011 to 3.59 per thousand beneficiaries. The prevalence was higher in open than in restricted schemes. In 2012, the prevalence of DYS was 2.59 and 4.48 per thousand beneficiaries in restricted and open schemes, respectively. The overall prevalence of DYS increased by 28%, from 2.82 in 2007 to 3.59 per thousand in 2012 as depicted in Figure 12. Figure 12: Average prevalence of dysrhythmias between 2007 and Prevalence rate per beneficiaries Year Dysrhythmias 21

24 Other CDL conditions CDL conditions outside the top ten most prevalent conditions had a prevalence of between 0.02 and 2.93 per thousand beneficiaries in Haemophilia (HAE) was the least prevalent condition in 2011 and Bipolar mood disorder (BMD) was one of the fastest increasing CDL conditions, increasing by 16% between 2011 (2.38 per 1 000) and 2012 (2.76 per 1000) across all schemes. BMD prevalence was higher in open than in restricted schemes. In 2012, prevalence was 2.19 and 3.27 per thousand beneficiaries in restricted and open schemes, respectively Top 10 CDL conditions: Figure 13 below depicts the trends in the top 10 common conditions between 2007 and The order of these conditions has remained mostly unchanged for the period under review. Hypertension, hyperlipidaemia and diabetes mellitus type 2 have shown the fastest increase. Other conditions, though increasing, have remained at rates below twenty per thousand beneficiaries. Figure 13: Top 10 CDL conditions:

25 Multiple CDL conditions: A number of beneficiaries of medical schemes were diagnosed and treated for multiple CDL conditions. Beneficiaries diagnosed with two CDL conditions increased by 31.2% from 28.2 in 2007 to 37.0 per 1000 beneficiaries in The prevalence of three simultaneous CDL conditions in beneficiaries on medical schemes also increased by 59.0% from 8.3 to 13.2 per thousand beneficiaries between 2007 and A number of beneficiaries with four or more CDL conditions increased by 63% from 1.5 in 2007 to 2.5 per thousand beneficiaries in Figure 14 depicts the trends in the prevalence of multiple conditions for the period between 2007 and Figure 14: Multiple CDL conditions: Multiple CDL rate per beneficiaries Two simultaneous CDLs Three simultaneous CDLs Four or more simultaneous CDLs Top 10 CDL conditions by scheme size: The 2011 and 2012 average prevalence per beneficiaries for the 26 CDL conditions in small, medium and large size schemes is shown in 23

26 Table 5 below. The prevalence of CDL conditions was highest in schemes with less than 6000 beneficiaries as shown below. This trend was reversed in the case of HIV, where the prevalence was higher in large schemes compared to medium and small schemes. 24

27 Table 5: Prevalence of chronic diseases: size CDL Small Medium Large % change % change % change ADS % % % AST % % % BCE % % % BMD % % % CMY & CHF % % % COP % % % CRF % % % CSD % % % DBI % % % DM % % % DM % % % DYS % % % EPL % % % GLC % % % HAE % % % HYL % % % HYP % % % IBD % % % IHD % % % MSS % % % PAR % % % RHA % % % SCZ % % % SLE % % % TDH % % % HIV % % % CC % % % CC % % % CC % % % 25

28 4 Discussion There has been a sustained upward trend in diagnosis and treatment of many chronic conditions on the Chronic Disease List. These increases may be due to improved data management systems of medical schemes and administrators, the worsening age and disease profile of beneficiaries, and increased beneficiary entitlement awareness. Behavioural change of members and providers can also explain the observed trends. The observed increase in the prevalence of CDL conditions far outstrips the 1.8% increase in the number of beneficiaries between 2011 and Changes in age and pensioner ratio may explain some of the observed changes in prevalence. Changes in risk profiles of schemes are as a result of beneficiary aging, scheme mergers and movement of beneficiaries or group of beneficiaries between open and restricted schemes. The upward trend in the prevalence of chronic disease is likely to continue as the risk profiles of schemes worsen. This is mostly true for small medical schemes. Small schemes, faced with an ever increasing burden of disease, will be left without a choice but to seek mergers with large medical schemes. This scenario is unfortunate because the reduction in the number of schemes is undesirable for competition and choice available to the public and beneficiaries of medical schemes. Large risk pools are in a better position to absorb the effects of increasing prevalence. The implications of more medical schemes beneficiaries with chronic diseases is an increase in GP and specialists visits, an increase in the use of medicines, and an increase in hospital events. Without aggressive intervention into the root causes of these chronic diseases and their costs, these trends are expected to continue to worsen. 26

29 5 References Council for Medical Schemes (2014). Gudelines for the Idenitification of Beneficiaries with Risk Factors in Accordance with the Entry and Verification Criteria: Version [cited March]; [Available from: Council for Medical Schemes (2013). Research Brief 3 of 2013: Trends in chronic disease prevalence in the S.A. medical aid schemes: [cited March]; [Available from: World Health Organization (2011). Global status report on noncommunicable diseases Geneva : World Health Organization