Consumers love to hate medical aids.
This is inevitable as medical aids are a “grudge purchase“. According to Discovery Health Medical Scheme‚ 80% of consumers will spend more on premiums than they get back from a medical aid each year.
About 20%‚ the sicker members‚ will receive back more than they spend.
Yesterday the Council for Medical Schemes‚ the medical aid regulator‚ released its annual report giving consumers a sneak peak into the industry. It also revealed which medical aids generated the most complaints.
The Council accepts complaints from consumers about medical aids‚ although members are supposed to approach their scheme first to resolve their issue.
These are the medical schemes that generated the most complaints per 1000 beneficiaries. In other words‚ they didn’t generate the highest number of complaints — but the highest percentage of complaints worked out by looking at how many complaints were filed compared to how many members belonged to the scheme:
1. Spectramed
2. Resolution Health Medical Schemes
3. Community Medical Aid Scheme (COMMED)
4. Genesis Medical Scheme
5. Medshield Medical Schemes
The council received 5223 complaints in total‚ 268 that were deemed invalid.
Complaints included members not having their conditions which are prescribed minimum benefits paid for in full as the law requires‚ to confusion over what the medical aids would pay for a procedure and what the member had to pay.
Yesterday‚ the Council highlighted which medical aids pay their principal officers (the boss) the most. The pay is not in any way linked to the number of members in a scheme and amount of money the medical aid manages.
-The head of the South African Police Service Medical Scheme took home R5.3 million. The medical aid has almost half a million members.
-The next best paid principal officer was Discovery Health Medical Scheme’s boss who earned R4.8 million‚ a 10.8% decrease from the year before. The scheme has almost 2.6 million members.
-Bestmed’s boss took R4.8 million rand. The scheme only has 190‚272 members.
-Liberty’s Medical Scheme’s Principal Officer earned just over R4 million. This is despite the fact that Liberty Scheme has only 116‚522 members and is being “closely monitored” by the Council for Medical Schemes. The Scheme is submitting regular reports as it has lost younger members who are less likely to claim and has older sicker members who claim and cost more.
A medical aid relies on younger‚ healthier members to subsidise older sicker members who go to hospital more often or use more medication. According to the Council‚ Liberty will address the challenges it is facing by “lowering non-healthcare expenses” and attracting younger members.
Liberty Medical Scheme spent the most on advertising and marketing – an average of R146.40 of each member’s premium was spent on marketing costs.
On average‚ R52‚40 of a member’s medical aid premium goes towards marketing and advertising costs.
The Council said yesterday it is continuing to try push medical schemes to reduce the money spent on “non healthcare” costs -money paid towards brokers‚ advertising and adminstration.
The report also found that:
•On average‚ people go to their GP four times a year.
•Women who give birth spend an average of three days in hospital.
•The average length of time people spend in hospital is 4.3 days.
•And South African women continue to love having C-sections. Of all pregnant women with medical aids‚ 70.7% of all women gave birth by C-section‚ which is more expensive than a natural birth.
How does your medical scheme perform?
Consumers love to hate medical aids.
This is inevitable as medical aids are a “grudge purchase“. According to Discovery Health Medical Scheme‚ 80% of consumers will spend more on premiums than they get back from a medical aid each year.
About 20%‚ the sicker members‚ will receive back more than they spend.
Yesterday the Council for Medical Schemes‚ the medical aid regulator‚ released its annual report giving consumers a sneak peak into the industry. It also revealed which medical aids generated the most complaints.
The Council accepts complaints from consumers about medical aids‚ although members are supposed to approach their scheme first to resolve their issue.
These are the medical schemes that generated the most complaints per 1000 beneficiaries. In other words‚ they didn’t generate the highest number of complaints — but the highest percentage of complaints worked out by looking at how many complaints were filed compared to how many members belonged to the scheme:
1. Spectramed
2. Resolution Health Medical Schemes
3. Community Medical Aid Scheme (COMMED)
4. Genesis Medical Scheme
5. Medshield Medical Schemes
The council received 5223 complaints in total‚ 268 that were deemed invalid.
Complaints included members not having their conditions which are prescribed minimum benefits paid for in full as the law requires‚ to confusion over what the medical aids would pay for a procedure and what the member had to pay.
Yesterday‚ the Council highlighted which medical aids pay their principal officers (the boss) the most. The pay is not in any way linked to the number of members in a scheme and amount of money the medical aid manages.
-The head of the South African Police Service Medical Scheme took home R5.3 million. The medical aid has almost half a million members.
-The next best paid principal officer was Discovery Health Medical Scheme’s boss who earned R4.8 million‚ a 10.8% decrease from the year before. The scheme has almost 2.6 million members.
-Bestmed’s boss took R4.8 million rand. The scheme only has 190‚272 members.
-Liberty’s Medical Scheme’s Principal Officer earned just over R4 million. This is despite the fact that Liberty Scheme has only 116‚522 members and is being “closely monitored” by the Council for Medical Schemes. The Scheme is submitting regular reports as it has lost younger members who are less likely to claim and has older sicker members who claim and cost more.
A medical aid relies on younger‚ healthier members to subsidise older sicker members who go to hospital more often or use more medication. According to the Council‚ Liberty will address the challenges it is facing by “lowering non-healthcare expenses” and attracting younger members.
Liberty Medical Scheme spent the most on advertising and marketing – an average of R146.40 of each member’s premium was spent on marketing costs.
On average‚ R52‚40 of a member’s medical aid premium goes towards marketing and advertising costs.
The Council said yesterday it is continuing to try push medical schemes to reduce the money spent on “non healthcare” costs -money paid towards brokers‚ advertising and adminstration.
The report also found that:
•On average‚ people go to their GP four times a year.
•Women who give birth spend an average of three days in hospital.
•The average length of time people spend in hospital is 4.3 days.
•And South African women continue to love having C-sections. Of all pregnant women with medical aids‚ 70.7% of all women gave birth by C-section‚ which is more expensive than a natural birth.
Would you like to comment on this article?
Register (it's quick and free) or sign in now.
Please read our Comment Policy before commenting.
Trending
Latest Videos