South African Medical Schemes Losing Members

The South African medical scheme industry is experiencing a decline in membership for the first time in over a decade. Here we will look at South African medical schemes losing members.

This alarming trend is reinforced with the disclosure that the number of medical schemes operating in the country has shrunk from 131 to 83 over the same period.

According to the latest Council for Medical Schemes (CMS) annual report, there are now 8 809 million members compared with 8 814 million the previous year.

The decrease heralded the first negative growth in membership of medical schemes since 2004.

Medical Scheme categories

Of the current 83 medical schemes in operation, 23 are open schemes with 60 falling into the restricted scheme category.

There are only a total of five “Very Large” schemes in South Africa with minimum memberships of 220 000.

The bulk of medical schemes, 34 in total, fall into the “Small” category with membership below the 15 000 mark.

Pensioner ratios – Medical Schemes Losing Members

Medical Schemes Losing MembersMedical schemes across the board display an increase in members over the age of 50 years.

This trend is also true in the increasing number of pensioner members.

The CMS also states that this trend has greater cost implications for medical schemes, which in turn can have a significant impact on the cost of health care.

Pensioner membership (people aged 65 years and older) has increased by 7.7%.

Restricted scheme average age membership is 30.5 years with a pensioner ratio of 6.1%. This too displayed a slight increase of 0.2%.

The overall ratios for all schemes showed an average age of 32.3 years and a pensioner ratio of 7.7%.

Another interesting trend revealed in the CMS report is the decrease in the number of dependents covered by medical schemes.

The membership ratios of dependents for both restricted and open schemes saw a decrease of 1.38% and 1.12% respectively.

Medical Schemes Losing Members – Negative growth rate

There were negative growth rates in medical aid membership in all provinces, excluding Gauteng and the Western Cape.

So membership figures dropped to 8 809 523 compared with 8 814 458 the previous year.

Medical Schemes Losing Members – Growing pressure

Decreasing membership figures and soaring health care costs is placing the medical scheme industry under growing pressure.

Expenditure on health care benefits paid out to members increased by 9% over the last year from R1272 billion to R138.6 billion.

Also, hospital expenditure took the lion’s share, claiming 37.1% of medical scheme expenditure.

Payment breakdown

  • Hospital fees cost R51.4 billion, with private hospital fees rising by 9.36%
  • Medicines and consumables claimed R22.3 billion representing 16.1% of expenditure
  • Health professionals got R10 billion, an increase of 12.65%
  • Specialists received R32.5 billion, an increase of 10.9%
  • GPs received R8.6 billion, an increase of 5.51%


So the CMS states that the figures serve to underline the importance of primary health care interventions to reduce the high cost of hospitalisation.

All info was correct at time of publishing