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Medical schemes
Among other objectives, PMBs want to achieve appropriate healthcare, resulting in lower costs associated with complications and hospitalisation. When beneficiaries are properly taken care of and their illnesses managed, the need for expensive hospitalisation decreases.
Medical schemes have a critical role to play in making PMBs work.
Schemes have to educate their beneficiaries about PMBs and the benefits that are included in them.
Schemes must inform their beneficiaries of their DSPs and keep them updated should any changes occur.
Schemes should empower their beneficiaries with information on matters such as the intricacies of rules and the formularies for specific conditions.
Medical schemes have to guarantee and ensure reasonable access and availability of DSPs.
The public sector cannot be designated as a DSP without the medical scheme ensuring that the necessary service will be available.