Sicker South Africans are costing medical aids more‚ explaining the next year’s increase in premiums of 10% or more in many schemes.
The Council for Medical Schemes Report‚ released to the media on Friday‚ showed that 15 of 23 open medical aids‚ meaning anyone can join them‚ incurred losses. This means they paid out in medical costs and administration fees more than they collected in premiums.
In restricted schemes‚ open only to employees of a certain company‚ 34 of 60 paid out more for sick members than they earned.
Since 2005‚ the number of younger‚ healthier members who claim less have dropped and the number of older‚ sicker people has risen substantially‚ according to the report.
This means medical aids are paying more and more for members’ illness as older people use hospitals more.
The regulator‚ which analyses all medical aid data‚ recorded an increase in the number of people with high blood pressure‚ high cholesterol‚ diabetes‚ asthma‚ and heart disease compared to 2014.
The most common chronic disease is high blood pressure.
For the first time since 2004‚ the medical aid industry representing 8 million beneficiaries has lost members instead of growing. This was mainly because the Government Employee Medical Schemes ( GEMS) lost 3% of its members
The Council’s Dr Anton de Villiers‚ General Manager of Research and Monitoring‚ is not sure why GEMS lost members‚ but said it could be a reduction in public servants overall or people in government cancelling their medical aid subscriptions due to financial pressure.
He said: “Usually healthier members who claim less are the first to go‚ which is not good for medical aids.” He said the council said it was concerned about the fact the industry was not growing.
Gems‚ the municipal union medical aid Samwumed‚ Resolution Health and Suremed lost a high percentage of members‚ which is seen as a negative for those particular schemes.
Of the R151.6 billion earned in 2015 from monthly premiums‚ R138.9 billion was spent on healthcare costs.
Hospitals get the lion’s share of the medical aid budget‚ about 37% or R51.1 billion.
On average each beneficiary of a medical aid claimed more than R1000 a month.
But usually 20% of members account for 80% of claims.
GEMS Principal Officer Guni Goolab has previously said only 5% of its members account for the highest spending.
The regulator’s annual report noted that medical aids with more spending on GPs have a lower hospital spend. Those where less money is spent on doctors tend to have a higher percentage of money on hospital spend.
This could highlight the importance of seeing a doctor and preventative care‚ such as detecting high blood pressure‚ rather than having a stroke and going to hospital.
— TMG Digital
Why medical aid costs will rise
Sicker South Africans are costing medical aids more‚ explaining the next year’s increase in premiums of 10% or more in many schemes.
The Council for Medical Schemes Report‚ released to the media on Friday‚ showed that 15 of 23 open medical aids‚ meaning anyone can join them‚ incurred losses. This means they paid out in medical costs and administration fees more than they collected in premiums.
In restricted schemes‚ open only to employees of a certain company‚ 34 of 60 paid out more for sick members than they earned.
Since 2005‚ the number of younger‚ healthier members who claim less have dropped and the number of older‚ sicker people has risen substantially‚ according to the report.
This means medical aids are paying more and more for members’ illness as older people use hospitals more.
The regulator‚ which analyses all medical aid data‚ recorded an increase in the number of people with high blood pressure‚ high cholesterol‚ diabetes‚ asthma‚ and heart disease compared to 2014.
The most common chronic disease is high blood pressure.
For the first time since 2004‚ the medical aid industry representing 8 million beneficiaries has lost members instead of growing. This was mainly because the Government Employee Medical Schemes ( GEMS) lost 3% of its members
The Council’s Dr Anton de Villiers‚ General Manager of Research and Monitoring‚ is not sure why GEMS lost members‚ but said it could be a reduction in public servants overall or people in government cancelling their medical aid subscriptions due to financial pressure.
He said: “Usually healthier members who claim less are the first to go‚ which is not good for medical aids.” He said the council said it was concerned about the fact the industry was not growing.
Gems‚ the municipal union medical aid Samwumed‚ Resolution Health and Suremed lost a high percentage of members‚ which is seen as a negative for those particular schemes.
Of the R151.6 billion earned in 2015 from monthly premiums‚ R138.9 billion was spent on healthcare costs.
Hospitals get the lion’s share of the medical aid budget‚ about 37% or R51.1 billion.
On average each beneficiary of a medical aid claimed more than R1000 a month.
But usually 20% of members account for 80% of claims.
GEMS Principal Officer Guni Goolab has previously said only 5% of its members account for the highest spending.
The regulator’s annual report noted that medical aids with more spending on GPs have a lower hospital spend. Those where less money is spent on doctors tend to have a higher percentage of money on hospital spend.
This could highlight the importance of seeing a doctor and preventative care‚ such as detecting high blood pressure‚ rather than having a stroke and going to hospital.
— TMG Digital
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