Discovery Health Medical Scheme’s (DHMS) approach to the funding of Inflammatory Bowel Disease treatments

Abstract

Inflammatory Bowel Diseases (IBD) such as Crohn’s disease (CD) and Ulcerative Colitis (UC) are listed under the Prescribed Minimum Benefits Chronic Disease List (CDL). As defined by the Council for Medical Schemes, Prescribed Minimum Benefits (PMBs) are a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. The purpose is to provide people with continuous care to improve their health and well-being and to make healthcare more accessible, if not affordable. The Council for Medical Scheme further clarifies that to manage risk and ensure appropriate standards of healthcare, so-called treatment algorithms were developed for the CDL conditions. The algorithms, which have been published in the Government Gazette, can be regarded as benchmarks, or minimum standards, for treatment. This means that the treatment the medical scheme must provide for may not be inferior to the algorithms.