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Designing a Cost Management Framework for a Medical Scheme Service Provider in South Africa

In: Designing Cost Management Systems to Support Business Decision-Making

Author

Listed:
  • Elbie Ward

    (North-West University)

  • Susanna L Middelberg

    (North-West University)

  • Pieter Buys

    (North-West University)

Abstract

The South African medical scheme environment is heavily regulated. Furthermore, healthcare costs are continuously on the rise, requiring medical schemes to be creative in managing their costs while offering quality healthcare. One of the innovative ways to manage costs, is channelling its members towards a cost-efficient, high quality medical specialist’s network. This case study focuses on the development of a framework that is able to detect and recommend the most cost-effective route in identifying quality medical specialists and channelling members thereto. The results illustrate that channelling members to cost-efficient, quality medical specialists can lead to substantial cost savings for the medical scheme. Through the involvement of key stakeholders, a solution was found to the problem of increasing medical costs to the benefit of all.

Suggested Citation

  • Elbie Ward & Susanna L Middelberg & Pieter Buys, 2021. "Designing a Cost Management Framework for a Medical Scheme Service Provider in South Africa," Springer Books, in: Pieter Buys (ed.), Designing Cost Management Systems to Support Business Decision-Making, chapter 0, pages 87-105, Springer.
    • Handle: RePEc:spr:sprchp:978-981-16-1751-5_5
    DOI: 10.1007/978-981-16-1751-5_5
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    More about this item

    Keywords

    Cost management; Healthcare service providers; Medical costs; Service provider networks;
    All these keywords.

    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • M41 - Business Administration and Business Economics; Marketing; Accounting; Personnel Economics - - Accounting - - - Accounting

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