Medical Aid Costs Rise as the Package of Care Shrinks

The increase in medical aid costs for members for the 2017 year has created distress in the medical aid consumer market. Even big organisations such as Discovery Health and Momentum Health have increased their fees. This has made it more difficult for them to maintain low fees to clients and has had an adverse effect on the premiums.

Increased medical aid costs

However, while these increases are taking effect, consumers are expected to accept little-improved benefits from their medical aid scheme.  The overall analysis shows that while medical scheme fees have continued to increase. The benefit for consumers regarding medical care has either remained the same or has decreased. In some instances, medical aid schemes have limited consumers to particular practitioners on their network of service providers. And provide differentiated claim disbursements for other practitioners. This, in essence, limits consumers’ choice to those provided by the scheme or take on the co-payment burden.

Medical Aid CostsIncreasingly consumers also receive percentage payments of claims, because there is no standardisation regarding doctors’ fees. Medical Aid Schemes claim without a standard rate for medical procedures. It will get difficult to plan and disburse claims, as such claims are paid out based on medical practitioner.

No active consumer body

Without an active consumer, body to advocate for fair treatment and to look out for the interests of the consumer. The members continually find themselves short changed and on the receiving end of poor medical aid policy decisions. Which has a direct impact on their medical aid costs? With the consumer in mind, the National Health Insurance organisation is trying to institute a single health insurance option. For all South African nationals. However, this has not materialised yet, leaving consumers at the mercy of private medical practitioners. Practitioners who increase fees on the basis that it will improve their ability to provide excellent benefits for consumers. To increase efficiencies, medical aid schemes have introduced managed care entities to monitor the medical fraternity. To ensure fair treatment and avoid inconsistencies and fraudulent activities that result in the client to pay for unnecessary procedures.

Contributing to medical aid costs

The schemes have also highlighted some contributing factors to the increase in contributions ranging from the weak Rand position to the importation of medical equipment or increase in hospital fees. And while there are options that the schemes can take to manage the impact of medical fraternity fee increases on the consumer, some of the options carry the risk of losing members who are the primary source of income for these schemes. As such medical schemes are developing new ways of trying to keep costs down such as the managed care plans which include consumer empowerment programmes and training to reduce the need for medical procedures and ultimately the claims on the medical fund.

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