Electronic health-care switches, that switch claims between service providers such as medical practitioners and pharmacies and members` medical aid schemes, have become big business over the past two years. Two of the electronic claims switches, QEDI and Mediswitch, merged in May this year after a lengthy process that included months of waiting for Competition Board approval, says Hennie du Plessis, MD of the merged entity, now known as Digital Healthcare Solutions (DHS).
QEDI, a wholly-owned subsidiary of PQ Africa, was formed in 1993 and provided services for about 6000 medical practitioners.
Mediswitch came into the market in 1998 as an initiative of the then Usko, now Bytes Technology Group, gained a dominant position in the pharmacy sector of the market with 2400 customers, and was switching claims for about 700 medical practitioners.
"Both companies were chipping into the other`s market and we realised that by combining forces we could expand into new markets," says Du Plessis.
On the medical practitioner side, between 30% and 40% of claims activity is electronic, so there is a big opportunity in this market, he says. Some doctors do not switch claims electronically but use bureaus that process their claims and submit them to the medical fund administrators. Some use both switching and bureau services.
Du Plessis says others still process and submit claims manually. "Since merging the two switches we are adding a net total of 70 new doctors a month to our service."
Med-e-Mass is being run as a separate division and, in addition to selling and supporting its practice management software, is responsible for new initiatives that are not related to claims switching.
"These include electronic procurement systems and smart-card solutions for managed health care," says Du Plessis.
DHS employs 200 people, operates six regional offices and contracts to 30 information technology (IT) dealers that sell practice management systems and train and support clients in outlying areas.
Du Plessis says doctors tend to lag in the use of IT, but this situation has improved because some schemes are offering incentives for claims submitted electronically.
Another value proposition is that they get paid quicker if claims are switched electronically.
An advantage is that the practitioner has access to historical data relating to claims transactions
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