Medical Aid is Expensive Yet Covers Much Less Than Previously

When Medical Aids in South Africa announced their premium increases for 2017, the consumer was shocked at the above-inflation increases by most major Medical Schemes. Medical aid is expensive in South Africa

With the inflation rate of 6%, the increases by Discovery Health (10.2%) Momentum Health (11.0%) and GEMS (13-16.8%).

So the South African Society for Anaesthesiologists (SASA) mentions that they are seeing below-inflation increases being paid to Practitioners and as Medical Scheme premiums increase it is becoming harder for the consumer to find funds to afford the cover.

Different Medical Schemes also pay differing amounts.

NO consumer body monitors or protects members of medical aids.

Medical Aid Is ExpensiveThe South Africa government is also moving towards a National Health Insurance (NHI) for all South Africans which will kerb rising costs. SASA supports this move, but in the meantime, there is an increasingly competitive Private Health Care system.

So medical Schemes are trying to keep costs down by introducing managed health costs.

Also, the question is this managed treatment benefitting the patient?

There are moves towards a global fee structure, but the worry is that there is a risk of members having to pay a lot more with rates going up and value of packages going down.

Medical Aids state these are the reasons they have to increase costs:

  1. Rising Costs of Medicines
  2. Increased costs of importing Equipment
  3. The falling Rand
  4. Health Practitioner is charging higher than the costs the schemes currently cover.
  5. Increase in the average age of members
  6. High Private Hospital Costs

So a report by Alexander Forbes Health in 2015 indicated that only just over a third of Medical Aids were able to maintain an operating surplus in 2014.

Choices for Medical Aids to keep Costs down – Medical aid is expensive

Medical aid is expensive, there are ways to keep the costs down.

  1. Increase Members contributions – may result in losing members
  2. Decrease Benefits – may result in losing members.
  • Decreasing payments to health care workers resulting to a great member’s co-payments.
  • Stricter network agreements – reducing members choice
  • Managed care benefits –not always in the best interests of the patient

 

Consumers must do their part

  • Adopt and encourage a healthy lifestyle for all beneficiaries.
  • Responsible for using benefits they do have-
  • Proactive –question Medical Aid care decisions. Attend board meetings.
  • Investigate. Choose the right option for your family which may not necessarily be the most expensive.
  • As a consumer, question if managed health organisations are adding the costs and resulting in negative outcomes.

 

Consumers have the right to Question.

When increases occur (particularly way above inflation), consumers must check that decisions regarding reduced payments to medical practitioners, are in fact for the consumers benefit, or if they will result in reduced patient care.

Ask questions about staff increases at Medical Aids. Are those increases in line with inflation?

So why have there been such large increases in Medical Aid premiums?

Is the member still receiving the Value they deserve?