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SOUTH AFRICAN QUALIFICATIONS AUTHORITY 
REGISTERED UNIT STANDARD: 

Describe managed care as it is applied in Medical Scheme Administration in South Africa 
SAQA US ID UNIT STANDARD TITLE
118019  Describe managed care as it is applied in Medical Scheme Administration in South Africa 
ORIGINATOR
SGB Insurance and Investment 
PRIMARY OR DELEGATED QUALITY ASSURANCE FUNCTIONARY
-  
FIELD SUBFIELD
Field 03 - Business, Commerce and Management Studies Finance, Economics and Accounting 
ABET BAND UNIT STANDARD TYPE PRE-2009 NQF LEVEL NQF LEVEL CREDITS
Undefined  Regular  Level 4  NQF Level 04 
REGISTRATION STATUS REGISTRATION START DATE REGISTRATION END DATE SAQA DECISION NUMBER
Reregistered  2018-07-01  2023-06-30  SAQA 06120/18 
LAST DATE FOR ENROLMENT LAST DATE FOR ACHIEVEMENT
2024-06-30   2027-06-30  

In all of the tables in this document, both the pre-2009 NQF Level and the NQF Level is shown. In the text (purpose statements, qualification rules, etc), any references to NQF Levels are to the pre-2009 levels unless specifically stated otherwise.  

This unit standard replaces: 
US ID Unit Standard Title Pre-2009 NQF Level NQF Level Credits Replacement Status
12318  Describe managed care as it is applied in Health Benefits Administration in South Africa  Level 4  NQF Level 04  Complete 

PURPOSE OF THE UNIT STANDARD 
This unit standard introduces the concept of managed care in Healthcare Benefits Administration. It will be useful for medical claims assessors, intermediaries and learners in Healthcare Benefits Administrators.

The qualifying learner is capable of:
  • Describing the rationale for managed care.
  • Explaining the principles of managed care.
  • Describing different aspects of a managed care programme.
  • Analysing the advantages and disadvantages of managed care. 

  • LEARNING ASSUMED TO BE IN PLACE AND RECOGNITION OF PRIOR LEARNING 
    There is open access to this unit standard. Learners should be competent in Communication and Mathematical Literacy at Level 3. 

    UNIT STANDARD RANGE 
    The typical scope of this unit standard is:
  • Stakeholders could include employees, employers, providers, members, intermediaries and Trustees.
  • Managed care includes, but is not limited to, designated service providers, medicine formularies, treatment protocols, alternative reimbursements, disease management and utilisation of facilities.
  • Reasons for managed care include, but are not limited to, the balance between cost, quality and access. 

  • Specific Outcomes and Assessment Criteria: 

    SPECIFIC OUTCOME 1 
    Describe the rationale for managed care. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    The concept of managed care is explained with examples and an indication is given of other places in the world that use managed care. 

    ASSESSMENT CRITERION 2 
    Reasons for the introduction of managed care are explained with reference to the South African situation. 

    ASSESSMENT CRITERION 3 
    The history of managed care in South Africa is researched and presented in the form of milestones. 

    ASSESSMENT CRITERION 4 
    The impact of Legislation on managed care in South Africa is explained with examples. 

    SPECIFIC OUTCOME 2 
    Explain the principles of managed care. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Five broad principles of managed care are analysed and the reason for each is explained as it applies in South Africa. 

    ASSESSMENT CRITERION 2 
    A model of managed care is analysed and at least three of the principles of managed care are identified in the model. 

    SPECIFIC OUTCOME 3 
    Describe different aspects of a managed care programme. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Three managed care programmes are analysed to determine how each addresses cost, quality and access. 

    ASSESSMENT CRITERION 2 
    The concept of utilisation management is explained with authentic examples. 

    ASSESSMENT CRITERION 3 
    The concept of disease management is explained with authentic examples. 

    ASSESSMENT CRITERION 4 
    The concept of a wellness programme is explained with authentic examples. 

    ASSESSMENT CRITERION 5 
    The importance of education for the success of a managed care programme is explained with reference to different stakeholders. 

    SPECIFIC OUTCOME 4 
    Analyse the advantages and disadvantages of managed care. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    The advantages and disadvantages of managed care are analysed with reference to the Department of Health, Medical Scheme Administrators, members, employers and providers. 

    ASSESSMENT CRITERION 2 
    Three stakeholders are interviewed on their opinions of managed care and the findings of the interviews are presented to a selected target group. 


    UNIT STANDARD ACCREDITATION AND MODERATION OPTIONS 
    This Unit Standard will be internally assessed by the provider and moderated by a moderator registered by a relevant accredited ETQA or an ETQA that has a Memorandum of Understanding with the relevant accredited ETQA. 

    UNIT STANDARD ESSENTIAL EMBEDDED KNOWLEDGE 
    N/A 

    UNIT STANDARD DEVELOPMENTAL OUTCOME 
    N/A 

    UNIT STANDARD LINKAGES 
    N/A 


    Critical Cross-field Outcomes (CCFO): 

    UNIT STANDARD CCFO ORGANISING 
    Learners are able to organise and manage themselves effectively by making the necessary arrangement for the interviews and completing their assignments in good time. 

    UNIT STANDARD CCFO COLLECTING 
    Learners are able to collect, organise and critically evaluate information in researching the milestones in managed care. 

    UNIT STANDARD CCFO COMMUNICATING 
    Learners are able to communicate effectively in explaining concepts and presenting their findings. 

    UNIT STANDARD CCFO DEMONSTRATING 
    Learners are able to demonstrate an understanding of the world as a set of related systems by recognising that problem-solving contexts do not exist in isolation in understanding the principles of managed care in balancing costs, quality and access and the affect of changes in legislation. 

    UNIT STANDARD ASSESSOR CRITERIA 
    N/A 

    REREGISTRATION HISTORY 
    As per the SAQA Board decision/s at that time, this unit standard was Reregistered in 2012; 2015. 

    UNIT STANDARD NOTES 
    This unit standard replaces unit standard no 12318 'Describe managed care as it is applied in Healthcare Benefits Administration in South Africa' (Level 4, Credits 6). 

    QUALIFICATIONS UTILISING THIS UNIT STANDARD: 
      ID QUALIFICATION TITLE PRE-2009 NQF LEVEL NQF LEVEL STATUS END DATE PRIMARY OR DELEGATED QA FUNCTIONARY
    Core  49356   Further Education and Training Certificate: Medical Claims Assessing  Level 4  NQF Level 04  Reregistered  2023-06-30  INSETA 
    Elective  49649   Further Education and Training Certificate: Long-term Insurance  Level 4  NQF Level 04  Reregistered  2023-06-30  INSETA 
    Elective  57613   Further Education and Training Certificate: Short-Term Risk Management  Level 4  NQF Level 04  Passed the End Date -
    Status was "Reregistered" 
    2012-06-30  INSETA 
    Elective  66613   Further Education and Training Certificate: Wealth Management  Level 4  NQF Level 04  Reregistered  2021-06-30  As per Learning Programmes recorded against this Qual 


    PROVIDERS CURRENTLY ACCREDITED TO OFFER THIS UNIT STANDARD: 
    This information shows the current accreditations (i.e. those not past their accreditation end dates), and is the most complete record available to SAQA as of today. Some Primary or Delegated Quality Assurance Functionaries have a lag in their recording systems for provider accreditation, in turn leading to a lag in notifying SAQA of all the providers that they have accredited to offer qualifications and unit standards, as well as any extensions to accreditation end dates. The relevant Primary or Delegated Quality Assurance Functionary should be notified if a record appears to be missing from here.
     
    1. African Resources & Financial Training (Pty) Ltd 
    2. ALCARI 233 CC T/A ALCARI (Eversdal)(TP) 
    3. CKP Development Agency (Pty) Ltd. 
    4. De Vries Management & Training Services cc 
    5. DSBI (Pty) Ltd 
    6. Duxah (Pty) Ltd 
    7. Faisit (Pty) Ltd 
    8. Intec College 
    9. Invuya Institute of Learning (Pty) Ltd 
    10. Masifunde Training Centre (Pty) Ltd 
    11. Old Mutual Life Assurance Company South Africa 
    12. Ray Strodl Consulting (Pty) Ltd 
    13. Sanlam Life Insurance Ltd 
    14. Sanlam Life Insurance Ltd. 
    15. The Institute of Health Risk Managers (Pty) Ltd 
    16. Umfolozi FET College - Central Office 



    All qualifications and part qualifications registered on the National Qualifications Framework are public property. Thus the only payment that can be made for them is for service and reproduction. It is illegal to sell this material for profit. If the material is reproduced or quoted, the South African Qualifications Authority (SAQA) should be acknowledged as the source.