The mining industry exposes mine workers to a myriad of on-site dangers and occupational diseases. This is why having a medical scheme and healthcare service provider that focuses entirely on the unique healthcare needs of mine workers can make all the difference when it counts.

Closed medical schemes are often better placed to meet the specific needs of their members, particularly when services are integrated with primary care and occupational health.

In the case of the mining industry, for example, closed schemes with specialised healthcare professionals, clinics, hospitals and pharmacies close to where mine workers work, are ideally positioned to deliver faster, more targeted care and early interventions for patients.

Platinum Health Medical Scheme is a closed medical scheme serving mine workers in the platinum and chrome industries in South Africa.

Understanding industry-specific risks

Dr Mel Mentz, Chief Operations Officer for Platinum Health’s Rustenburg Region, says: “In a closed scheme there's typically a better understanding of the needs of a defined group, so you can tailor the benefits to meet the needs of the members.”

Dr Matome Sekgala, Chief Operations Officer for Platinum Health’s Limpopo and Mpumalanga regions, elaborates: “In the mining sector, for example, there may be a higher incidence of TB, occupational lung diseases or allergies to platinum salts. Where a GP in an urban area might not automatically refer a patient for x-rays for a cough, medical practitioners serving the mining sector specifically will be very familiar with the symptoms of these occupational diseases and will screen for them.”

Dr Mentz says a closed scheme that also offers primary care and occupational health services is better positioned to understand the patient’s full history, the environment they work in, and the risks associated with poor control of chronic conditions.

Screening for early diagnosis

A closed medical scheme offering, occupational health services makes periodic screenings compulsory. This gives the scheme an opportunity for early detection, diagnosis and treatment.

Dr Mentz says: “Where occupational health and the medical scheme are separate, there is typically a gap in understanding of the patient’s full history, which can impact early diagnosis and treatment. But with a full, compulsory occupational health assessment, we check vitals, blood pressure, cholesterol, blood glucose, urine, hearing and lung function, do a chest x-ray and offer HIV screening. Depending on the patient’s risk profile, we might also include a heat tolerance test to determine the patient’s fitness to work underground.”

This battery of tests allows us to detect a number of occupational conditions, non-communicable and/or communicable diseases at an early stage and refer patients for appropriate treatment.

Dr Sekgala says early screening, early detection and early intervention not only improves patient outcomes – it also improves mine safety and productivity.

“When someone’s got a problem, it's easier for us to identify it quickly, start intervention or even engage with the relevant stakeholders in the mines. These interventions might include identifying alcohol and drug abuse and linking the patient to the appropriate mental health support; or engaging the occupational health practitioner to ensure patients being treated for cancer are not exposed to conditions their bodies can’t cope with. We're trying to prevent long-term complications through early detection, and by monitoring compliance with prescribed treatment.”

Dr Mentz says: “When primary care, occupational health and medical scheme services are integrated, you achieve a single view of the patient. Having to undergo an annual medical even though the patient is healthy allows for early diagnosis of any problem, which will then be flagged in their health profile to ensure they receive appropriate treatment, and the condition is properly controlled. That offers huge benefits.”

Integrated health and wellness

Closed medical schemes that partner with employers on wellness programmes are also well positioned to improve the health of workforces.

Dr Sekgala highlights Platinum Health’s HIV awareness programmes, screening, treatment and support as an example: “We drove our HIV programmes for many years, and we have made good progress. 95% of all our members know their HIV status, approximately 11,500 who are on treatment,” he says.

In-house resources, channel model to control costs

Dr Mentz says a key advantage of a closed scheme with a Staff Model Health Maintenance Organisation (HMO) model is that costs of health service delivery can be better managed. “Where the closed scheme appoints its own general practitioners, dentists, psychologists, optometrists, radiographers, physiotherapists and audiologists, and manages its own pharmacies, clinics and hospitals, it can optimise cost efficiencies.”

Schemes with a focus on primary healthcare, screening and careful management of chronic conditions, can also better manage costs and improve patient outcomes, he notes.

Dr Mentz says: “We see that more and more of our members are realising the benefits of being part of a medical scheme and are also registering their dependants so they can enjoy better healthcare. Benefits like maternity cover are a huge advantage to the member if they intend to have a family.”