Differentiate between fee for service contracted DSP’s and Capitation (or other differentiated reimbursement models) service providers clearly demonstrating ease of access to members taking into consideration infrastructural limitations such as presence or absence of public transport in area of member concentration relative to DSP. Explain member education processes and communication strategy in place. Is it clear, understandable and in plain language for members to comprehend? How has the provision of Demonstrate that access to health this service by your care is fair and equitable. organisation improved New members should be geographical access to accommodated across all geographical healthcare of medical areas. Explain and indicate location of scheme beneficiaries. service provision in terms of the geographical spread of medical scheme beneficiaries covered by the contract. Explain approach towards limiting access implicitly as well as explicitly and provide reasons for each limitation. Highlight contractual obligations to support motivation Cost Quantify the financial Indicate in of quarterly and benefit/cost to medical annual cost schemes through utilising Provide detailed analysis of the your organisation’s difference between contribution services in terms of income to the scheme and capitation healthcare expenditure. fees charged per member and dependants and in Rand value and percentage of contributions. Due to the nature of capitation arrangements the net financial effect to each scheme should be positive.
Differentiate between fee for service contracted DSP’s and Capitation (or other differentiated reimbursement models) service providers clearly demonstrating ease of access to members taking into consideration infrastructural limitations such as presence or absence of public transport in area of member concentration relative to DSP. Explain member education processes and communication strategy in place. Is it clear, understandable and in plain language for members to comprehend? How has the provision of this service by your organisation improved geographical access to healthcare of medical scheme beneficiaries. Demonstrate that access to health care is fair and equitable. New members should be accommodated across all geographical areas. Explain and indicate location of service provision in terms of the geographical spread of medical scheme beneficiaries covered by the contract. Explain approach towards limiting access implicitly as well as explicitly and provide reasons for each limitation. Highlight contractual obligations to support motivation Cost Quantify the financial benefit/cost to medical schemes through utilising your organisation’s services in terms of healthcare expenditure. Indicate in of quarterly and annual cost Provide detailed analysis of the difference between contribution income to the scheme and capitation fees charged per member and dependants and in Rand value and percentage of contributions. Due to the nature of capitation arrangements the net financial effect to each scheme should be positive.
MHC%20Self%20Evaluating%20Checklist%202011.docx