SAQA

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SOUTH AFRICAN QUALIFICATIONS AUTHORITY

REGISTERED UNIT STANDARD THAT HAS PASSED THE END DATE:

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	6
REGISTRATION STATUS		REGISTRATION START DATE	REGISTRATION END DATE	SAQA DECISION NUMBER
Passed the End Date - Status was "Reregistered"		2018-07-01	2023-06-30	SAQA 06120/18
LAST DATE FOR ENROLMENT		LAST DATE FOR ACHIEVEMENT
2026-06-30		2029-06-30

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	6

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	Passed the End Date - Status was "Reregistered"	2023-06-30	INSETA
Elective	49649	Further Education and Training Certificate: Long-term Insurance	Level 4	NQF Level 04	Passed the End Date - Status was "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	Passed the End Date - Status was "Reregistered"	2023-06-30	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.

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