MEMBERS’ RISK PROFILE

ONE OF the most important factors that contributes to a medical scheme’s performance is the risk profile of its members. Some of the key statistics are:

• The average age of beneficiaries;

• The pensioner ratio (defined as the percentage of beneficiaries over the age of 65); and • The average family size. The Alexander Forbes report says the average age of beneficiaries has remained fairly constant since 2005, with a marginal increase from 32.3 years in 2015 to 32.5 years in 2016. The average age of members of open and restricted schemes increased slightly in 2016, with open schemes experiencing a slightly bigger increase.

The average age of beneficiaries on open schemes increased by 0.2 years to 34 years, while the average age on restricted schemes increased from 30.5 to 30.6 years at the end of 2016.

“As a scheme ages, we expect the average claims per member to increase, with a generally accepted benchmark of a 2% increase in average claims per year increase in average age,” the report says.

The average pensioner ratio increased from 7.7% to 7.9% in 2016. Open schemes have experienced a greater increase in the pensioner ratio than restricted schemes, with an increase from 8.8% to 9.2% from 2015 to 2016, compared with an increase from 6.1% to 6.3% on restricted schemes.

In 2016, the average family size for restricted schemes increased slightly from 2.38 to 2.39.