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 THAT HAS PASSED THE END DATE:

Describe managed care as it is applied in Health Benefits Administration in South Africa

SAQA US ID	UNIT STANDARD TITLE
12318	Describe managed care as it is applied in Health Benefits 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	6
REGISTRATION STATUS		REGISTRATION START DATE	REGISTRATION END DATE	SAQA DECISION NUMBER
Passed the End Date - Status was "Reregistered"		2004-12-02	2005-04-13	SAQA 1657/04
LAST DATE FOR ENROLMENT		LAST DATE FOR ACHIEVEMENT
2006-04-13		2009-04-13

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 is replaced by:

US ID	Unit Standard Title	Pre-2009 NQF Level	NQF Level	Credits	Replacement Status
118019	Describe managed care as it is applied in Medical Scheme Administration in South Africa	Level 4	NQF Level 04	6

PURPOSE OF THE UNIT STANDARD

This unit standard introduces the concept of managed care in Healthcare Benefits Administration.

The qualifying learner is capable of:

Describing the rationale for managed care.

Explaining the broad principles of managed care.

Describing different aspects of a managed care programme.

Identifying 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:

1.Stakeholders could include employees, employers, providers, members, intermediaries and Trustees.

Specific Outcomes and Assessment Criteria:

SPECIFIC OUTCOME 1

Describe the rationale for managed care.

ASSESSMENT CRITERIA

ASSESSMENT CRITERION 1

1. The concept of managed care is explained in own words.

ASSESSMENT CRITERION 2

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

ASSESSMENT CRITERION 3

3. An indication is given of other places in the world that use managed care.

ASSESSMENT CRITERION 4

4. Five reasons why the principles of managed care have been adopted are named for the South African healthcare environment.

ASSESSMENT CRITERION 5

5. Legislation governing managed care in South Africa is named and an indication is given of how managed care has influenced south African legislation.

ASSESSMENT CRITERION 6

6. An indication is given of how legislation has influenced managed care in South Africa.

SPECIFIC OUTCOME 2

Explain the principles of managed care.

ASSESSMENT CRITERIA

ASSESSMENT CRITERION 1

1. Five broad principles of managed care and the reason for each as it applies in South Africa are presented in a table.

ASSESSMENT CRITERION 2

2. The importance of the balance between cost, quality and access is explained in a healthcare system.

ASSESSMENT CRITERION 3

3. 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

1. Three managed care programmes are identified as used by an Healthcare Benefits Administrator.

ASSESSMENT CRITERION 2

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

ASSESSMENT CRITERION 3

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

ASSESSMENT CRITERION 4

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

ASSESSMENT CRITERION 5

5. A managed care programme is identified, the objectives are stated and the tools used are identified for particular Healthcare Benefits Administrator.

ASSESSMENT CRITERION 6

6. The importance of education for the success of a man.

SPECIFIC OUTCOME 4

Analyse the advantages and disadvantages of managed care.

ASSESSMENT CRITERIA

ASSESSMENT CRITERION 1

1. Advantages of managed care to the Department of Health, Healthcare Benefits Administrators, members, employers and providers are listed in a table.

ASSESSMENT CRITERION 2

2. Disadvantages of managed care to the Department of Health, Healthcare Benefits Administrators, members, employers and providers are listed in a table.

ASSESSMENT CRITERION 3

3. 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 INSQA or a relevant accredited ETQA. The mechanisms and requirements for moderation are contained in the document obtainable from INSQA, - INSQA framework for assessment and moderation.

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 assignment in good time.

UNIT STANDARD CCFO COLLECTING

Learners are able to collect, organise and critically evaluate information in researching the milestones in managed care and preparing a presentation based on interviews.

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 effect of changes in legislation.

UNIT STANDARD CCFO CONTRIBUTING

Learners are able to participate as responsible citizens in understanding the importance of the education of stakeholders for the success of a managed care programme.

UNIT STANDARD NOTES

This unit standard has been replaced by 118019, which is "Describe managed care as it is applied in Medical Scheme Administration in South Africa", Level 4, 6 credits.

QUALIFICATIONS UTILISING THIS UNIT STANDARD:

	ID	QUALIFICATION TITLE	PRE-2009 NQF LEVEL	NQF LEVEL	STATUS	END DATE	PRIMARY OR DELEGATED QA FUNCTIONARY
Core	20639	National Certificate: Healthcare Benefits Administration: Claims Assessing	Level 4	NQF Level 04	Passed the End Date - Status was "Registered"	2004-12-05	INSETA
Elective	48493	National Certificate: Financial Services: Wealth Management	Level 4	NQF Level 04	Passed the End Date - Status was "Registered"	2007-02-11	Was INSETA until Last Date for Achievement

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.

NONE