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A new survey on the SA private healthcare market shows that while the choice of schemes is growing, the landscape is becoming increasingly complex.

The GTC 2018 Medical Aid Survey (MAS) revealed that purely in terms of premiums, Fedhealth emerged as the medical aid which held the most top positions across all the classifications. 

Discovery was ranked in first place for a medical aid’s overall ‘health’ and longevity in terms of factors such as its solvency level, membership growth, net healthcare result and member satisfaction. 

When combining affordability and the other factors, Discovery claimed the highest number of top positions.
 
“It is encouraging – when drilling down into the details – to see such a variety of participants offering options across all sub-sections of the medical aid spectrum, meaning consumers can confidently access more schemes and plans offering private healthcare, and so decrease the burden on the government”, said Jill Larkan, Head: Healthcare Consulting at GTC.
 
“We always welcome more competition among schemes, as it indicates a growing market and more variety for members with changing healthcare needs. However, this does add more complexity to a healthcare arena that is already difficult to navigate for the majority of members,” she said. 
 
She cautioned that many of the schemes attempt to attract members who are worried about the high cost of healthcare, by offering so-called manageable premiums.

These are perceived to be of good value, but in fact, have far fewer benefits than their traditional counterparts. 

“It is now more important than ever for members not only to look at the price – which remains the most important consideration for many members under ever increasing financial strain – whilst also considering which benefits they are forfeiting for their lower premium,” she said.
 
Since 2006, medical aid premiums have increased by 104.87% cumulatively, while salaries increased by 80.20%.
 
“These entry-level plans are a good option for members who are new to the private healthcare market and are happy to have a combination of a primary health care and hospital plan,” said Larkan.

“Those members who expect slightly more comprehensive coverage but limit themselves to the cheaper plans, as a means to minimising cost, will be disappointed when they find out that they are not covered for a number of procedures they might have expected. 

“In healthcare, the mantra ‘you get what you pay for’ could not be more apt.”
 
She noted that the Council for Medical Schemes (CMS) reported to Parliament earlier this year that complaints from medical aid members have increased by 29% from 1 017 to 4 536 during 2017-18, compared to the previous year. 

This was largely attributed to a lack of understanding of the cover provided by their medical aids.
 
“This is in line with our experience: one of the biggest reasons for members’ unhappiness about a selected scheme is not knowing what their plan pays for. As there is no standardisation in the medical aid industry, it is very complicated for members to analyse medical aids, without the help of experienced professionals,” she said.
 
Larkan concluded: “Given the complexity of the medical aid industry and the varying needs of members, it is more important than ever for members, with the help of their healthcare advisor, to do a thorough analysis of their needs and means; and compare this to the options available in the healthcare market, before deciding on a scheme and then a plan option for their future.”

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