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2008.12 Health Benefit Tracker Template

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2008.12 Health Benefit Tracker Template Powered By Docstoc
					Discovery Health Benefit Tracker
December 2008




1. Membership                                                                                                     2.2 Top conditions ranked by average cost
                                                                       December 2008
Total number of lives managed                                                                      2.05 million   The top conditions ranked by the average cost per admission are shown below. The average cost per condition
                                                                                                                  represents the total cost for all admissions divided by the number of admissions.

2. Hospital-related costs

Hospital costs represent the total cost for all authorised hospital admissions paid by the scheme. Total cost     Top conditions ranked by average cost                                    January 2008 to December 2008
includes all payments to hospitals, specialists and support providers such as radiology and pathology.            Long term ventilation through tracheostomy                                                          R545 792
                                                                                                                  Liver transplant                                                                                    R476 878
                                                                                                                  Heart and/or lung transplant                                                                        R447 983
                                                                                            January 2008 to       Burns with skin graft                                                                               R427 234
                                                                       December 2008
                                                                                            December 2008         Premature babies 2 000 – 2 499 g with major operations                                              R372 420
Total hospital costs                                                      R345.13 million         R8.91 billion   Premature babies < 1 000 g with major operations                                                    R367 424
                                                                                                                  Skull, spine, hip and major limb operation for trauma                                               R301 943
2.1 Top 10 conditions ranked by number of admissions                                                              Babies > 2 499 g with operations                                                                    R274 214
                                                                                                                  Major cardiac operations with catheterisation                                                       R258 273
All conditions are defined using diagnosis related groups (DRGs) that group admissions into clinically            Premature babies 1 000 – 1 499 gm with major operations                                             R253 938
homogeneous groups. The top conditions ranked by number of admissions are shown below.
                                                                                                                  2.3 Top 10 highest hospital cost admissions

                                                                              Number of admissions                Highest hospital costs related to admissions between January 2008 to December 2008
                                                                                            January 2008 to
Top conditions ranked by number of admissions                          December 2008
                                                                                            December 2008                                                             Age of member                             Length of stay
                                                                                                                  Condition                                                                Total cost
Caesarean delivery                                                                 1 441               22 629                                                         (years)                                   (days)
Gastroenteritis and abdominal pain                                                 1 296               22 395     Premature babies < 1 000 g                                 Less than 1           R2 099 174                    231
Tonsil and adenoid operations                                                        874               13 925     Operations of the arteries and veins in the chest                  55            R1 704 054                     86
Pneumonia and whooping cough                                                         810               16 638     Major operation to repair heart malformation                       22            R1 626 657                    108
Digestive system disorders                                                           703               14 131     Burns with skin graft                                              61            R1 429 739                    122
Cataract operations                                                                  702               15 848     Premature babies 2 000 – 2499 gm                           Less than 1           R1 338 878                    141
Operations of the uterus and ovaries for cancer which has not spread                 574                9 540     Skull operation                                                    39            R1 243 777                     88
Vaginal delivery                                                                     552                9 423     Operations of the nervous system                                   17            R1 241 812                    123
Arm and hand operations                                                              535                9 890     Operations for major injuries                                      58            R1 097 209                     48
Other ear, nose, mouth and throat disorders                                          505                9 146     Premature babies < 1 000 g                                 Less than 1           R1 064 744                    128
                                                                                                                  Minor lung procedures                                              42             R963 347                      54
Total cost for top 10 conditions                                              R85 million         R1.87 billion
3. Chronic conditions and further disease management                                                                4. Preventive care

The following table shows the number of members claiming for a registered chronic condition through Discovery       Vitality incentivises members to get actively involved in improving their health. Apart from encouraging members to
Health’s Chronic Illness Benefit. The total paid represents the total amount paid for chronic medicines over the    exercise and lead a healthy lifestyle, Vitality also encourages the early detection of disease. The Screening Benefit
past year.                                                                                                          offers members access to preventive screening for a number of chronic conditions. Members are rewarded through
                                                                                                                    the Vitality programme for participating in these screening tests.

                                                                      Members               Total paid
Chronic overview                                                                  206 005           R1.19 billion
                                                                                                                                                                                                           Number of tests
3.1 Top 10 chronic conditions as shown by the total cost to the scheme                                                                                                                                               January 2008 to
                                                                                                                    Vitality screening                                                        December 2008
                                                                                                                                                                                                                     December 2008
The chronic conditions below represent the conditions that accounted for the largest spend on chronic medicines     Blood pressure                                                                          4 820                50 762
for the scheme. These conditions represent the conditions defined in terms of the Prescribed Minimum Benefits,      Cholesterol                                                                            11 612               389 047
as well as the additional chronic conditions approved by Discovery Health — up to 65 conditions depending on
                                                                                                                    Glucose                                                                                14 060               266 909
plan choice.
                                                                                                                    HIV                                                                                     7 451                88 966
                                                                                                                    Mammograms                                                                                667                64 556
                                                                                                                    Pap smears                                                                              3 587               108 253
                                                                      Members registered in December 2008
                                                                                                                    Prostate screening                                                                      2 446                59 273
Hypertension                                                                                            164 455
Hyperlipidaemia                                                                                          91 443     5. Emergency care
Asthma                                                                                                   51 323
Diabetes mellitus type 2                                                                                 34 714     Discovery 911 and the International Travel Benefit provides peace of mind to Discovery Health members in the event
Major depression                                                                                         16 684     of an emergency, locally or internationally.
Diabetes mellitus type 1                                                                                 15 332
Epilepsy                                                                                                 11 579     Discovery 911 is a nationwide group of highly trained paramedics in rapid response vehicles who will assist Discovery
HIV and AIDS                                                                                             11 295     Health members with all aspects of their emergency.
Bipolar mood disorder                                                                                     7 784
Chronic renal failure                                                                                     1 334     Members on all plans, except KeyCare have cover for medical emergencies when travelling internationally. The
                                                                                                                    International Travel Benefit provides cover for emergency medical expenses outside the borders of South Africa,
                                                                                                                    including evacuation and medically necessary repatriation costs.
3.2 Oncology Management Programme

The table below shows the total number of members enrolled on the Oncology Management Programme.
                                                                                                                                                                                                                     January 2008 to
                                                                                                                                                                                              December 2008
                                                                                                                                                                                                                     December 2008
                                                                      Number of members on active                   Number of incidents that Discovery 911 paramedics attended to                            1 176               17 642
                                                                      treatment in December 2008                    Number of international emergency cases managed                                            472                6 509
Organ cancer                                                                                             15 417
Blood cancer                                                                                              2 107
Localised cancer                                                                                          1 173     Note
Other cancers                                                                                               615
                                                                                                                    The data presented in the Health Benefit Tracker includes information on Discovery Health Medical Scheme and the
Total cost over last 12 months                                                                      R1.29 billion   11 closed schemes administered by Discovery Health.