Current Medical Scheme Trends

Since the year 2000, the cost of membership fees for medical schemes in South Africa has increased by 63.5%. Read further for more on current medical scheme trends.

While this has helped the medical scheme industry to provide cover for ever-increasing health care costs. It has also negatively impacted on membership growth.

Affordability remains a key issue facing the medical scheme industry as membership growth remains stagnant.

Members of medical schemes paid a whopping R151.6 billion in contributions in the last financial year under review by the Council for Medical Schemes.

Risk contributions – excluding funds from medical savings accounts – also increased by 7.7% to R136.7 billion.

The escalation train continued unabated and reflected an increase of 12.2% – R14.9 billion – in contributions to medical scheme savings accounts.

Medical Scheme Trends – Global Overview 

Globally, the ratio of physicians per 10 000 of the population is 13.9.

The South African ratio is way below that mark at a mere 7.8, outstripped by countries such as Brazil and China.

  • Brazil                        18.9
  • China                        14.9
  • South Africa            7.8
  • India                         7.0
  • African Region        2.7

 

Reasons for concern

This trend raises concerns about the performance of South Africa’s overall health system, particularly because of the health care reforms envisaged with the introduction of National Health Insurance (NHI).

The NHI policy seeks to provide equitable access to health services by all South Africans.

Deficiencies must be addressed

Medical Scheme TrendsIt is envisaged that current resource deficiencies will be augmented by contracting arrangements with the private sector.

It will also enable access to audiologists and speech therapists at South African schools.

An example of this initiative is the NHI’s primary health care re-engineering platform that will focus on access to registered nurses at ward level.

According to figures released by the Council for Medical Schemes (CMS), only Gauteng and the Western Cape have more registered nurses than medical scheme beneficiaries.

The breakdown shows:

Gauteng – 48.1 nurses to 39.8 beneficiaries

Western Cape  – 18.9 nurses to 15.5 beneficiaries

The rest of the country is experiencing nursing shortages.

The hardest hit is North West, in order of nursing shortages by Northern Cape, Limpopo, Mpumalanga, Eastern Cape, Free State and KwaZulu-Natal.

The way forward

The scope of complementary services provided by medical schemes and distribution of primary health care resources in the private sector will, therefore, be affected by NHI policy intervention:

  • The distribution of primary health care professionals as private providers within the NHI framework
  • The need for medical schemes to spread provider networks to enable access to medical benefits

 

Conclusion on Medical Scheme Trends

The distribution and availability of human resources are the cornerstones of South Africa’s forward-thinking health policies.

The availability or lack of health resources where people live and work can either improve or impair access to health care services.

It is therefore vitally important that both public and private partnerships form by health care providers to ensure the future wellbeing of all the country’s citizens.

 

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