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Good quality cover is still the focus

In March this year, Patrick Masobe took on a different role and moved to Liberty Health as managing director of Vmed, the administration business of Liberty Health. Masobe was born in Sebokeng, completed his BA (economics) in the USA, and then joined the Wits Centre for Health Policy. Masobe has also completed a Masters in health economics and health financing at the London School of Economics. In 1999 he became a consultant to the Department of Health, and joined the Council for Medical Schemes in 2000.

The move to Liberty took place earlier this year and Masobe says he is enjoying the changes and openness of Liberty - "because we are developing the business."

And while he says there is a different focus - overall "it is still about good quality cover."

Good quality cover, says Masobe, is about three things. "You have to be clear about the benefits you offer." Benefits for both emergency cover - access to emergency services and hospitals and out of hospital benefits - especially chronic cover.

These benefits then have to be offered at affordable costs.

And thirdly, quality cover is also about the service itself - what happens when you are in hospital, what do the doctors do, and the process.

Vmed is focused on administration and Masobe believes that the three things that make for good administration are people, systems and the strategy.

"The people have to be passionate and smart and give good service," comments Masobe. "We also have very good systems and that gives us an advantage." Vmed uses Neil Harvey & Associates - a tested system that "enables our business," he says. A system that is also very useful in detecting fraud. Fraud is an issue that can cost industry over R10bn, and medical schemes need to identify, flag and deal with problematic claims as early as possible.

"But ultimately it is about the strategy you build, and making sure that it can be well executed."

Healthcare the world over has a focus on costs. Masobe says that costs are a function of price and utilisation. "Sometimes, they are not always in your control." Some costs are set by outside parties, like governments, and while negotiation can be a powerful tool, if you are a small player they can often be out of your hands. "So we need to manage utilisation, and this is influenced by managed care and benefit options."

As an administrator, Masobe says Vmed has a unique model. A technologically enabled administrator with a focus on the back office, and a keen focus on going into emerging markets. By the end of 2009 the goal is to have a presence in 10 African countries and in 17 African countries by 2010. Liberty offers administration through Vmed and they have developed a Liberty Health Blue product for their clients. While the administration is run out of Cape Town, each country ha a front office that will deal with clients and collate claims for processing in South Africa. Masobe says regulation in Africa is not as developed as in South Africa. "South Africa has had a long experience with health insurance and some African countries are only now starting to look at this." But as the market grows, legislation is likely to develop.

Making comparisons with South Africa and other African countries can turn into a political game. But we had to ask Masobe about Aids in Africa. He comments that in Africa, due in no small part to leadership, the case load is coming down. Masobe says African leaders talked about Aids and prevention and condoms. In South Africa? A lot more effort can be put into treating people.