As a knowledge based organisation, the effective dissemination of information to industry stakeholders is critical. This is done through the media, seminars and workshops, newsletters and other communication modalities to four key industry stakeholder groupings, namely; medical schemes and administrators; medical scheme members and consumers; regulatory authorities and relevant government departments; business and labour organisations.

The overall focus of the Benefit and Risk department is on minimising risks to which schemes are exposed in providing benefits for their members. It ensures that benefits are designed, worded and coded in such a way that there is little or no opportunity for misuse or abuse.

Three panels support the work of the Benefit & Risk Department: the Clinical Advisory Panel (CAP), the Coding and Hospital Panel (CHEP) and the Criteria Committee.

The role of the department is to provide technical input on systemic and strategic health industry issues from a medical schemes perspective to:

• Members of BHF
• Stakeholders in the medical schemes industry
• Government
• Consumer representative organisations
• Health service providers
• Regulatory bodies

The Health Systems and Policy Unit was established in August 2006. The Unit aims to contribute meaningfully to current and future healthcare financing debates in Southern Africa and beyond. The unit seeks to achieve this through high quality research, the creation and management of a data warehouse and constructive engagement with policymakers and industry stakeholders alike. Areas of focus include:

• Healthcare Charter Process
• Social Health Insurance (SHI) and Risk-Equalisation Fund (REF)
• Low Income Medical Schemes (LIMS)
• Basic Benefit Package
• Provider re-imbursement models
• Cost drivers in the health sector
• Planning and simulation models tracking the health system impact
• Implications of health sector public-private interactions.
• Challenges to obtaining universal coverage