Medical scheme members get less
HEALTHCARE: OUT-OF-POCKET PAYMENTS GREW BY 13.4% IN 2016
SA’s 8.8 million medical scheme beneficiaries’ contributions are going up and their benefits are going down.
The share paid to hospitals has grown over three years while the share of medication spend has shrunk.
SA’s 8.8 million medical scheme beneficiaries contribute on average R1 543.20 a month to their medical scheme. The Council for Medical Schemes’ recent annual report shows members’ out of pocket payments grew 13.4% year-onyear in 2016, representing 18.6% of total benefits paid. The biggest items members paid for themselves were out-of-hospital medication and supplementary and allied healthcare.
Schemes in 2016 paid on average R1 423.60 per beneficiary per month or 92% of the equivalent contribution on healthcare. Of that, over a third was paid to hospitals; 15.8% was paid by medical schemes for medication.
Supplementary and allied healthcare professionals were paid R103.21 per average beneficiary per month and general practitioners (GPs) R84.41.
All specialists accounted for 24.02% of healthcare benefits paid in 2016. They received R431.94 per average beneficiary per month.
The monthly administration cost per average beneficiary came to R132.40.
The average benefits paid to service providers per discipline per event differed, with the highest being R2 935.67 paid to anaesthetists.
GPs were on average paid R369.20 per event, up only 4.42% from the previous year. They were on average paid R861.45 for in-hospital consultations, but R328.00 for out-of-hospital visits.
The amounts paid to private hospitals and all specialists per average beneficiary per year have increased consistently in real terms over the last decade.
In 2016 alone, it increased 9.22% to private hospitals and 9.34% to all specialists in real terms.
Growing healthcare expenditure has outpaced increases in contributions since 2000.
Gross contributions per average beneficiary per month have grown 64.9% in real terms, but healthcare expenditure grew 70.5%.