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 annual conference showcases the sector, drawing people not only from the medical scheme sector, but many other related organisations including government departments, actuaries, switching houses, insurance brokers and various provider associations. The conference is seen as a unique opportunity to network and hear of latest trends and developments both locally and internationally. The focus is generally on issues of a more strategic nature.

Forensic Management Unit

A recent initiative of the BHF, the Forensic Management Unit (FMU) has already achieved significant success, saving the medical healthcare industry several hundred million Rands. Established in August 2003, the FMU enjoys the support of over 90% of the industry, including professional associations, regulatory bodies and funders. Its overall objectives are to contain the costs of private healthcare through the prevention of fraud and abuse which costs the industry some R8 billion annually. Representatives of the industry who form the FMU have compiled collective protocols for investigating, assessing and punishing fraud, while safeguarding the rights of those under investigation. They have established a common language which allows duly constituted and consistent decision-making. As both funders and providers participate in the FMU, a united front is presented when engaging with government on both public and private initiatives. A main strategic focus is to lobby for specific healthcare fraud legislation permitting prosecutors and courts specialised in fraud in the healthcare industry. A long-term objective would be to expand this initiative to the public sector. This centralised repository of information avoids duplication by roleplayers and draws together an industry-wide network of investigators to share information. Investigators operate within a strict legal framework following agreed and clearly outlined procedures.

Trustee Development Programme

More than ever before, Trustees of medical schemes are entrusted with the Governance of their scheme and have the responsibility of ensuring that any decisions made regarding the operational aspects of the scheme are made prudently and within a strict legal framework. In order to equip Trustees with the requisite knowledge, BHF have developed a Trustee Development Programme which covers aspects such as:

• The legal and fiduciary responsibilities of Trustees, including fiduciary and statutory functionality, general responsibilities, fiduciary duties, high risk responsibilities, investing medical scheme funds.
• A review of market dynamics in light of the current and proposed medical scheme legislation in SA, including the implementation of Social Health Insurance, system, the Risk Equalisation Fund, PMB's, mandatory cover, solvency, tax subsidy issues, etc.
• Act 101 - The effect on medical schemes of the Single Exit Price and the new dispensing license obligations.
• Designing benefits and contracting designated service providers.
• HIV/AIDS - what Trustees should know when making funding decisions, including the management of the disease and the impact to medical schemes.
• Combating medical scheme fraud and abuse through collective action