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Medical aid Part A 22 Aug - Council for Medical …

ANNUAL REPORT 2016/2017 HEALTHMATTERSANNUAL REPORT 2016/2017 // HEALTH MATTERSCOUNCIL FOR Medical SCHEMESANNUAL REPORT 2016/2017 Council for Medical SchemesPrivate Bag X34 Hatfi eld 0028 Tel 012 431 0500 Fax 0862 068 260 Email 121/2017 ISBN: 978-0-621-45437-6 ACONTENTS1 ANNUAL REPORT 2016/2017 // HEALTH MATTERSList of tables 2 List of figures 4 List of annexures 5A // GENERAL INFORMATIONC ouncil for Medical schemes general information 6 Acronyms, abbreviations and definitions 8 Legislative and other mandates 10 Profile and vision 12 Mission and values 12 Strategic goals 13 Our leadership: the Council 14 Our leadership: the executives 15 Medical schemes registered in terms of the Medical schemes Act 16 Organisational structure 17 Chairperson s report 18 Overview of the acting CEO & Registrar 20B // PERFORMANCE INFORMATIONS tatement of responsibility for performance information 48 Overview of CMS performance per programme 2016/2017 49 Annual performance report by program

ANNUAL REPORT 2016/2017 // HEALTH MATTERS COUNCIL FOR MEDICAL SCHEMES ANNUAL REPORT 2016/2017 Council for Medical Schemes

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1 ANNUAL REPORT 2016/2017 HEALTHMATTERSANNUAL REPORT 2016/2017 // HEALTH MATTERSCOUNCIL FOR Medical SCHEMESANNUAL REPORT 2016/2017 Council for Medical SchemesPrivate Bag X34 Hatfi eld 0028 Tel 012 431 0500 Fax 0862 068 260 Email 121/2017 ISBN: 978-0-621-45437-6 ACONTENTS1 ANNUAL REPORT 2016/2017 // HEALTH MATTERSList of tables 2 List of figures 4 List of annexures 5A // GENERAL INFORMATIONC ouncil for Medical schemes general information 6 Acronyms, abbreviations and definitions 8 Legislative and other mandates 10 Profile and vision 12 Mission and values 12 Strategic goals 13 Our leadership: the Council 14 Our leadership: the executives 15 Medical schemes registered in terms of the Medical schemes Act 16 Organisational structure 17 Chairperson s report 18 Overview of the acting CEO & Registrar 20B // PERFORMANCE INFORMATIONS tatement of responsibility for performance information 48 Overview of CMS performance per programme 2016/2017 49 Annual performance report by programme 49 Programme 1: Administration 49 Programme 2: Strategy Office 61 Programme 3: Accreditation Unit 63 Programme 4: Research and Monitoring Unit 65 Programme 5: Stakeholder Relations Unit 67 Programme 6: Compliance and Investigation Unit 69 Programme 7: Benefits Management Unit 71 Programme 8.

2 Financial Supervision Unit 73 Programme 9: Complaints Adjudication Unit 75C // GOVERNANCEC orporate governance report 78 Accounting Authority: The Council 78 Internal control 81 Internal audit 81 Risk management 82 Materiality and significance framework 83 Health, safety and environmental issues 83 Report of the audit and risk committee 84 Our commitment 86D // HUMAN RESOURCE MANAGEMENTR esources utilisation and talent management 88 Orientation, induction, training and development 88 Remuneration and staff benefits 88 Performance management 88 Employee wellness and health & safety 89 Employee relations 89 Social responsibility 89 Employment equity 89 Future HR plans 89HR oversight statistics 90E // FINANCIAL INFORMATIONS tatement of responsibility and confirmation of accuracy for the annual report 96 Report of Auditor-General 97 Annexure A Auditor-General s responsibility for the audit 100 Annual financial statements 101F // THE Medical schemes INDUSTRY IN 2016 Demographic information 128 Healthcare benefits 134 Utilisation of healthcare services 146 Resources

3 155 Contributions, relevant healthcare expenditure and trends 174 Risk transfer arrangements 184 Non-healthcare expenditure 187 Reinsurance results 196 Trends in non-healthcare expenditure 197 Net healthcare results and trends 210 Accumulated funds, solvency and solvency trends 212 Investments 221 Claims-paying ability of schemes 223 Administrator market 223 ANNEXURESD etails on the Medical schemes industry in 2016(See disc on inside back cover)2 ANNUAL REPORT 2016/2017 // HEALTH MATTERSLIST OF TABLEST able 1: schemes under close monitoringTable 2:Registered benefit options as at 01 March 2017 Table 3:Beneficiaries on EDO and non-EDO options 2013 2016 Table 4:Net healthcare results of EDOs and non-EDOs 2013 2016 Table 5:Membership age profile of EDOs and non-EDOs 2016 Table 6:EDO option summary as at 31 December 2016 Table 7:Average gross contribution increases for 2016/2017 benefit and contribution review periodTable 8:Average monthly gross contribution for 2017 Table 9:Average monthly risk contribution for 2016/2017 benefit and contribution review periodTable 10:Administrators and self-administered schemes accreditedTable 11.

4 Managed care organisations and self-administered scheme accreditedTable 12:Individual brokers and broker organisations accreditedTable 13:Broker accreditation withdrawnTable 14:New broker applications rejectedTable 15:Brokerage accreditation withdrawnTable 16:Number of complaints received and resolved in 2016 compared to 2015 Table 17:Resolution turnaround times for complaints in 2016 Table 18:Rulings on resolved complaints against regulated entities in 2016 Table 19:Number of complaints resolved in 2016, by categoryTable 20:Number of complaints resolved by category (2015 and 2016)Table 21:Internal dispute resolution activities for open Medical schemes with most complaints per 1 000 beneficiariesTable 22:Internal dispute resolution activities for closed Medical schemes with most complaints per 1 000 beneficiariesTable 23:Total number of trustees who attended training sessions during 2016/2017 Table 24:Consumer education and awareness sessionsTable 25:Key performance indicators, planned targets and actual achievements of Sub-programme 26:Budget of Sub-programme 27:Key performance indicators, planned targets and actual achievements of Sub-programme 28:Budget of Sub-programme 29.

5 Key performance indicators, planned targets and actual achievements of Sub-programme 30:Budget of Sub-programme 31:Key performance indicators, planned targets and actual achievements of Sub-programme 32:Budget of Sub-programme 33:Key performance indicators, planned targets and actual achievements of Programme 2 Table 34:Budget of Programme 2 Table 35:Key performance indicators, planned targets and actual achievements of Programme 3 Table 36:Budget of Programme 3 Table 37:Key performance indicators, planned targets and actual achievements of Programme 4 Table 38:Budget of Programme 4 Table 39:Key performance indicators, planned targets and actual achievements of Programme 5 Table 40:Budget of Programme 5 Table 41:Key performance indicators, planned targets and actual achievements of Programme 6 Table 42:Budget of Programme 6 Table 43:Key performance indicators, planned targets and actual achievements of Programme 7 Table 44:Budget of Programme 7 Table 45:Key performance indicators, planned targets and actual achievements of Programme 8 Table 46:Budget of Programme 8 Table 47:Key performance indicators, planned targets and actual achievements of Programme 9 Table 48:Budget of Programme 9 Table 49.

6 Composition of new Council as at 31 March 2017 Table 50:Membership of Council Committees as at 31 March 2017 Table 51:Remuneration of Council members 2016/2017 Table 52:Meetings & attendance of the Audit and Risk Committee in 2016/2017 Table 53:Personnel costs by programmeTable 54:Personnel costs by salary band Table 55:Performance rewardsTable 56:Training costs by programmeTable 57:Employment and vacancies by programmeTable 58:Employment and vacancies by salary bandTable 59:Employment changes by salary band 2016/2017 Table 60:Reasons for staff leaving 2016/2017 Table 61:Labour relations: misconduct and disciplinary action 2016/2017 Table 62:Employment equity current status and targets (Male) 2016/2017 Table 63:Employment equity current status and targets (Female) 2016/2017 Table 64:Employment equity current status and targets (Disabled) 2016/2017 Parts A DA3 ANNUAL REPORT 2016/2017 // HEALTH MATTERST able 1: Number of schemes by size and type as at 31 December 2015 and 2016 Table 2:Membership of schemes 2015 and 2016 Table 3:Average age of beneficiaries and pensioner ratio 2014, 2015 and 2016 Table 4:Provincial changes in beneficiaries 2015 2016 Table 5:Top 10 Disease Treatment Pairs (DTP) conditionsTable 6:Utilisation of primary healthcare services in 2015 and 2016 Table 7.

7 Statistical distribution of the number of beneficiaries, visits and amounts paid to primary health providers 2016 Table 8:Utilisation of specialist healthcare services in 2015 and 2016 Table 9:Statistical distribution of the number of beneficiaries, visits and amounts paid to specialist providers in 2016 Table 10:Utilisation of hospital facilities in 2015 and 2016: Admission RatesTable 11:Utilisation of hospital facilities in 2015 and 2016: Average Length of Stay (ALOS)Table 12: Inpatient ( 24 hours) across all hospital types by admission category in 2015 and 2016 Table 13:Hospital admissions by level of care and other outcomes: 2015 and 2016 Table 14:Utilisation of Medical technology in 2015 and 2016 Table 15:Maternal health coverageTable 16:General practitioners per 10 000 beneficiaries by province (2016)Table 17:Global comparison of physicians per 10 000 populationTable 18:Open scheme deviation from industry average 2015 and 2016 Table 19:Restricted scheme deviation from industry average 2015 and 2016 Table 20:Contributions and relevant healthcare expenditure pabpm 2000 2016 Table 21:Contributions and relevant healthcare expenditure per average beneficiary per month 2000 2016 (2016 prices)Table 22:Significant risk transfer arrangements 2015 and 2016 Table 23.

8 schemes with highest risk transfer arrangement losses 2016 Table 24:Options with highest risk transfer arrangement losses: 2016 Table 25:Accredited managed healthcare service fees (no transfer of risk) for options with a claims ratio above 100% 2016 Table 26:Accredited managed healthcare services (no transfer of risk) of 10 largest schemes : 2016 Table 27:Ten open schemes with the highest administration expenditure above industry average of pabpm (2016)Table 28:Ten restricted schemes with the highest administration expenditure above industry average of pabpm (2016)Table 29:Administration fees paid to third-party administrators per average beneficiary per month: 2015 and 2016 Table 30:Ten schemes with highest trustee fees: 2015 and 2016 Table 31:Ten schemes with highest remuneration for Principal Officers: 2016 Table 32:Top ten open schemes with the highest advisory* services feesTable 33:Top ten restricted schemes with the highest advisory* services feesTable 34:Ten schemes with highest Annual General Meeting costs: 2016 Table 35: schemes with broker fees above the industry average per average member per month 2015 and 2016 Table 36:Gross administration expenditure (GAE) per average beneficiary per month 20


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