SAQA 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.
SOUTH AFRICAN QUALIFICATIONS AUTHORITY 
REGISTERED UNIT STANDARD: 

Analyse the implications of the South African Government's National Health Policy and the potential impact on medical schemes 
SAQA US ID UNIT STANDARD TITLE
242582  Analyse the implications of the South African Government's National Health Policy and the potential impact on medical schemes 
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 6  Level TBA: Pre-2009 was L6  10 
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 does not replace any other unit standard and is not replaced by any other unit standard. 

PURPOSE OF THE UNIT STANDARD 
This Unit Standard is intended for learners who work at a senior or strategic level in healthcare benefits administration and/or advise on medical schemes and products. They require a holistic view of the medical scheme administration sub-sector and the potential or real impact of Government policy on the sector. It would be useful for senior people in administration and managed care, professionals who consult to medical schemes, Risk Managers, Medical Advisors, Trustees, Medical Scheme Consultants, Healthcare Intermediaries, Broker Consultants, Client Liaison officers, employees of the Council for Medical Schemes, Systems Designers, Actuaries, Principal Officers, and Senior Operational Administrative Staff.

The qualifying learner is capable of:
  • Analysing the goals of the National Health Policy (NHP) in relation to access and redress.
  • Critically evaluating the effectiveness of the current regulatory environment in support of Government goals for healthcare.
  • Investigating the potential costs to medical schemes of implementing National Health Policy goals.
  • Investigating industry initiatives in response to the National Health Policy. 

  • LEARNING ASSUMED TO BE IN PLACE AND RECOGNITION OF PRIOR LEARNING 
    It is assumed that learners are competent in Communication and Mathematical Literacy at NQF Level 4 and are working towards or have a Level 5 Financial Services Qualification or equivalent. 

    UNIT STANDARD RANGE 
    The typical scope of this Unit Standard is:
  • The Legislation includes, but is not limited to, National Health Act, Medical Schemes Act, Pharmacies Act, Medicine and Controlled Substances Act, Compensation for Occupational Injuries and Diseases Act (COIDA), Road Accident Fund (RAF), Financial Advisory and Intermediary Services Act (FAIS), Financial Advisory and Intermediary Services Act, (FAIS) Access to information Act, The Competitions Act, legislation governing the distribution of medical facilities and resources including doctors, pharmacies and nurses.
  • Impact of National Health Policy includes, but is not limited to, Low Income Medical Schemes (LIMS), Government Employees Medical Schemes (GEMS), Prescribed Minimum Benefits (PMBs) and Risk Equalisation Fund.
  • Resources include both traditional and conventional medical services, primary, secondary and tertiary healthcare.
  • Cost drivers include, but are not limited to burden of disease, inclusion of primary healthcare in prescribed minimum benefits, managed healthcare, wellness initiatives, brain drain, new drugs and technology. 

  • Specific Outcomes and Assessment Criteria: 

    SPECIFIC OUTCOME 1 
    Analyse the goals of the National Health Policy (NHP) in relation to access and redress. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    The National Health Policy is analysed with reference to the political goals of delivery and sustainability. 

    ASSESSMENT CRITERION 2 
    The goals of the National Health Policy are evaluated against the needs of the nation and available resources. 

    SPECIFIC OUTCOME 2 
    Critically evaluate the effectiveness of the current regulatory environment in support of the Government's goals for healthcare. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Legislation that regulates medical schemes is identified and evaluated in terms of how the legislation supports the goals for healthcare. 

    ASSESSMENT CRITERION 2 
    Legislation relating to solvency requirements is interrogated in terms of the merits, demerits, practicality and sustainability. 

    ASSESSMENT CRITERION 3 
    The cost implications of legislated requirements are discussed with reference to systems, reporting, risk pooling for cross subsidisation and other issues related to implementation. 

    SPECIFIC OUTCOME 3 
    Investigate the potential costs to medical schemes of implementing the National Health Policy (NHP) goals. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Healthcare costs to medical schemes are researched with reference to cost drivers. 

    ASSESSMENT CRITERION 2 
    Non-healthcare related costs to medical schemes are researched with reference to fraud, member and provider abuse, administration costs, technology, return on investment, payroll tax and types of remuneration. 

    SPECIFIC OUTCOME 4 
    Investigate industry initiatives in response to the National Health Policy. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Initiatives to introduce low cost medical schemes are discussed with reference to goals, current legislation and cost. 

    ASSESSMENT CRITERION 2 
    Initiatives to support cost management are discussed with reference to mergers and acquisitions, lifestyle programmes, managed care, clinical coding and quality assurance. 

    ASSESSMENT CRITERION 3 
    Initiatives relating to consumer education are discussed with reference to membership, cost containment and value for the consumer. 


    UNIT STANDARD ACCREDITATION AND MODERATION OPTIONS 
  • Anyone assessing a candidate against this Unit Standard must be registered as an assessor with the relevant ETQA or ETQA where a Memorandum of Understanding (MOU) exists with the relevant ETQA.
  • Any institution offering learning that will enable achievement of this Unit Standard must be accredited as a provider through the relevant ETQA or ETQA where a Memorandum of Understanding (MOU) exists with the relevant ETQA.
  • Moderation of assessment will be overseen by the relevant ETQA according to the moderation guidelines and the agreed ETQA procedures. 

  • 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 COLLECTING 
    The learner is able to collect, organise and critically evaluate information in investigating costs and industry initiatives. 

    UNIT STANDARD CCFO COMMUNICATING 
    The learner is able to communicate effectively in discussing industry initiatives. 

    UNIT STANDARD CCFO DEMONSTRATING 
    The learner is able to see the world as a set of related systems in analysing the implications of the NHP and the impact on medical schemes. 

    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 
    Search words: Healthcare benefits administration, Healthcare delivery system, Trustees, National health policy. 

    QUALIFICATIONS UTILISING THIS UNIT STANDARD: 
      ID QUALIFICATION TITLE PRE-2009 NQF LEVEL NQF LEVEL STATUS END DATE PRIMARY OR DELEGATED QA FUNCTIONARY
    Elective  66611   National Certificate: Wealth Management  Level 5  Level TBA: Pre-2009 was L5  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 UNION SKILLS DEVELOPMENT PTY LTD 
    2. ALCARI 233 CC T/A ALCARI (Eversdal)(TP) 
    3. Boland Public FET College - Central Office 
    4. CKP Development Agency (Pty) Ltd. 
    5. COLLEGE OF CAPE TOWN 
    6. College of Cape Town - Central Office 
    7. False Bay College 
    8. Intec College 
    9. Masifunde Training Centre (Pty) Ltd 
    10. North Link College 
    11. Old Mutual Life Assurance Company South Africa 
    12. Ray Strodl Consulting (Pty) Ltd 
    13. Ripple Effect 4 (Pty) Ltd 
    14. Sanlam Life Insurance Ltd 
    15. Sanlam Life Insurance Ltd. 
    16. South Cape College 
    17. South Cape Public FET College - Central Office 
    18. The Institute of Health Risk Managers (Pty) Ltd 
    19. Umfolozi FET College - Central Office 
    20. Universal Healthcare Services (Pty) Ltd 



    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.