The primary objective of this study was to assess the characteristics of patients admitted for COVID-19, ‘J18.9 Pneumonia, unspecified organism’ and other types of diagnoses. The aim was to assess as to what extent do COVID-19 related admissions changed to pneumonia, and as to what extent do ‘J18.9 Pneumonia, unspecified organism’ related admissions that changed to COVID-19 diagnosis at discharge stage. The secondary objective of the study was to assess’ predictors of readmissions in private hospitals. The review period was private hospital claims received by the scheme between January and August 2020. The inclusion criteria for COVID-19 admissions were patients that had a laboratory-confirmed (RT – PCR assay) COVID-19. Predictors of readmissions were modelled using logistic regression. The study found that restricted scheme patients admitted for a COVID-19 diagnosis changed to a ‘J18.9 Pneumonia, unspecified organism’ diagnosis. The converse was found to be true in that some patients that were admitted as J18.9 Pneumonia, unspecified organism’ diagnosis changed to a COVID-19 diagnosis. This study showed underlying factors associated with hospital admissions and predictors of readmissions in private hospitals. Keywords: COVID-19, Diagnosis, Hospitalisation, ICD-10, Pneumonia, Risk factors

Background: Orthoptists are specialists in diagnosing and treating ocular movement disorders and problems related to how the eyes work together, known as binocular vision. There is currently about 1 100 orthoptist registered and working in the UK. The comparative figure to South Africa is much lower at only nine registered orthoptists. Study design and objectives: This was a cross-sectional research study of claims paid for Orthoptists services by medical schemes. The study's primary objectives were to assess benefits paid for Orthoptists services, the level of co-payment subjected to members of medical schemes, and the funding model employed by medical schemes. The study entailed secondary data collected from the Council for Medical Schemes Annual Statutory returns. Results: The total number of beneficiaries with at least one orthoptist visit was 204, and the total number of visits paid by schemes was 256. This translates to the average number of one visit per beneficiary per annum. Each visit amounted to an average expenditure of R540. These services attracted a co-payment to the rand amount of R148 per visit. Nearly half of these benefits were paid from the person's medical savings account, accounting for 48% of benefits. Conclusion and recommendations: Coupled with evidence that there are currently no training schools for orthoptists and a low revenue base, this study shows that the demand for the services is lower than in previous years. The study recommends a review of the current model to a more multidisciplinary team across all specialties, particularly seeing that the first world countries still utilise the services of orthoptists in various health sectors, including child development and mainstream schools.

Breast and cervical cancers are among the top five worldwide. Over half of untreated breast cancer patients die, compared to nearly 90% of cervical cancer patients. Early breast and cervical cancer screening can reduce mortality risk. This study examined breast and cervical cancer rates among South African medical scheme members. The study’s secondary goal was to analyse how medical schemes funded these two cancers, including patient and/or out of pocket payments, to identify funding gaps. The study was a cross-sectional retrospective review of medical scheme claims data for oncology benefits, especially for breast and cervical cancers. The study used a multivariate logistic regression model to assess cancer rates. The results showed that the relative proportion of beneficiaries with breast cancer was higher in open schemes than restricted, in large schemes than medium and small schemes, in comprehensive plans, Efficiency Discount Options (EDOs), and hospital plans than in partial cover plans, and in age bands older than 55 in an out of hospital settings than in in-hospital settings. The paper advises examining the funding mechanism of oncology benefits to reduce Out of Pocket Payments (OOPs) for cancer patients, revising network arrangements, and using DSP as a barrier to access against uneven oncology provider distribution.

The mass media have penetrated so deeply in our Society that i~ is important to examine the types and nature of the influence the mass media exert on individuals in society. "Today in our cities, most learning occurs outsid~ the ~Iassroom. ~he sheer quantity of information conveyed by press-magazmes-!llm-T~-radlo far exceeds the quantity of information conveyed by school mstructlon.and .texts. This challenge has destroyed the monopoly of the books as ? teachmg aid and cracked the very walls of the classroom so suddenly that we re confused, baffled,(Sontag, 1968, p137)~ The influence can be di~id~d into t~ree b~sic linguistic, psychological and social. This essay Will mvolve discusSion of linguistic type in relation to education.

Background: Vision impairment (VI) affects people worldwide, and demographic factors like age are significantly linked to VI. Routine eye exams and other eye care treatments can detect and prevent common eye illnesses. However, many lack access to these services.Aim: This study's major objective was to analyse the distribution and funding of eye care services by medical schemes in South Africa. Setting:The study was conducted in the private sector in South Africa for benefits paid by medical schemes to optometrists, ophthalmologists and orthoptists.Methods: A retrospective, longitudinal study of eye care services claim data from the Council for Medical Schemes (CMS) annual reports. The review period was 2020, and scheme-level data were gathered and analysed at the aggregated rather than benefit option level. Results:In 2020, eye care benefits comprised 3.1% of total benefits paid; this proportion remained at the same levels throughout the review period. Closed schemes spent more per beneficiary per year than open schemes for optometrists, orthoptists and ophthalmologists. Self-administered schemes had 11% copayment for ophthalmology services, whereas outsourced schemes had less than 10%. Conclusion:Optometrists had higher copayments than ophthalmologists and orthoptists. Medical schemes with capitated models had a lower average expenditure than other types of models, and the operating model affected expenditure; self-administered schemes spent less on optometry benefits when adjusted for beneficiaries. The study suggests reviewing eye care benefit funding models (risk vs savings), administration activities and managed care models for cost savings and health quality.Contribution: This research contributes to the discussion and implementation of universal health insurance coverage through national health insurance in South Africa. The research shows that there are not enough eye care services in the public sector and that there are different funding gaps in the private sector.