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HIV & VCT Campaign: Role of Medical Schemes

HIV & VCT Campaign: Role of Medical Schemes. 8m lives 3.4m members (employed and pensioners) Closed (employer based schemes) and open schemes Medical schemes pick up its liability PMB. HIV prevalence % 2007 CMS Report:. Registration when in advanced phase of disease True prevalence:

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HIV & VCT Campaign: Role of Medical Schemes

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  1. HIV & VCT Campaign:Role of Medical Schemes

  2. 8m lives • 3.4m members (employed and pensioners) • Closed (employer based schemes) and open schemes • Medical schemes pick up its liability • PMB

  3. HIV prevalence %2007 CMS Report: • Registration when in advanced phase of disease • True prevalence: • +300%

  4. HIV & PMB:largely curative focus • VCT • Co-trimoxazole as preventative therapy • Screening and preventative therapy for TB • Diagnosis and treatment of sexually transmitted infections • Pain management in palliative care • Treatment of opportunistic infections • Prevention of mother-to-child transmission of HIV • Post-exposure prophylaxis following occupational exposure or sexual assault • ARVs

  5. Campaign benefits that are not included in PMB HGT testing Hb testing BP Condoms Some not really screening tests! Engage with CMS

  6. VCT & PMB • No guide to minimum benefits • At least one a year • Preferably two a year • Price proposal? • NDoH/Clicks initiative: R80 • Supported by the BHF • Longer term VCT service for all providers

  7. Codes for VCT • Diagnosis code (ICD10) • Z11.4 • Special screening examination for Human Immunodeficiency Virus (HIV) • Data collection: Concern about quality of diagnosis coding • Procedure code • Non existent (industry using dummy or consult codes) • NDoH to introduce code/s (including cost of materials) • VCT including 2nd test and materials • Monetary value for the service

  8. Prevention Gap in SA • High STI & High HIV • Chlamydia screening (17-24y): 0% (HQA 2009 Report) • 70-75% of infected women asymptomatic • Less in men • For prevention of STI/HIV spread (7% pick up in US) • USPSTF recommendation • Price of POC kit • Retail list price: (R8.50 to R26 + Vat) + markup • Tariff 3906 cannot be used (Lab) • Nappi • 495111 • 533492 • 626745 • 453634

  9. Recruitment • Medical schemes to actively recruit beneficiaries to present themselves for VCT/STI screening • Message on statements • Advertising • Member communiqués • Provider communiqués • Press • …

  10. Healthcare Quality 2008 *MAG conference 2002

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