Are Medical Schemes Paying for Unnecessary Hospital Admissions?

Medical scheme beneficiaries spend well below the international norm on an average number of days in a private hospital. Here we will look unnecessary hospital admissions.

This trend suggests that low-risk patients systematically go to hospital.

At the other end of the scale, medical schemes have reported that beneficiaries spend a significantly higher number of days in provincial hospitals.

The Council for Medical Schemes (CMS) says this anomaly can be attributed to the quality of data and that admission rates should be interpreted with caution.

Hospital Admission Statistics and Unnecessary Hospital Admissions

According to the latest annual report submitted to the CMS, on average patients spend 4.22 days in private hospitals compared with 10.04 days in provincial hospitals.

However, there were only 19 061 provincial hospital admissions with 1 456 877 admissions to private hospitals.

Here is a breakdown of the number of days spent in hospital by medical scheme beneficiaries. These figures are on a one per/1 000 beneficiary ratio.

  • Hospices (cancer patients) 16.21
  • Drug and Alcohol Rehab 12.83
  • Mental Health Institutions – 11.24
  • Provincial Hospitals – 10.04
  • Sub-acute facilities – 9.91
  • Private Hospitals – 4.22



Unnecessary Hospital AdmissionsThe number of recorded hospital deaths, based on a one per/1 000 beneficiary ratio, is 10.71.

The CMS is collaborating with medical schemes to improve the quality of data relating to the death of patients shortly after being discharged from a hospital.


The number of medical scheme beneficiaries undergoing CT scans has nearly doubled over the last two years – a trend which the CMS will be closely monitoring.

MRI scans, angiograms, bone density scans and dialysis services are also on the increase.

On the decrease, however, are the number of mammograms and pap smears.

Teenage birth rate – Unnecessary Hospital Admissions

The number of births to female beneficiaries between the ages of 15 to 19 years decreased during the year under review.

Based on a one per/1 000 medical scheme beneficiary statistics reveal that the number of birth admissions of females between the ages of 15 to 19 years dropped to 13.5 compared with 14.63 the previous year.

However, there was a slight increase in the number of birth admissions of females below 15 years of age – from 0.55 to 0.58.

Other pregnancy statistics

  • Number of Pap smears 15 – 69 years – 13.5 compared with 166 the previous year
  • Inter Uterine Contraceptive Device insertions 15 – 49 years – 7.41 (7.37)
  • Number of preventive pregnancy surgical procedures – 9 117 (9 063)
  • Sub-dermal Contraceptive implants 15 – 49 years – 0.11 (0.16)


Also, women undergoing Caesarian sections increased to 674.81 per/1000 medical scheme beneficiaries from 667.46 the previous year.

The number of men who underwent preventive fertility surgical procedures also increased to 6 143 compared with 5 857 the previous year.

So pregnancy-related health care remains one of the most expensive items paid for by South African medical schemes.


All info was correct at time of publishing