Con­fused about med­i­cal cover? Here’s help

The an­nual GTC sur­vey pro­vides a stan­dard­ised comparison and rank­ing of the med­i­cal scheme op­tions avail­able to you. re­ports

Weekend Argus (Saturday Edition) - - FRONT PAGE -

CHOOS­ING a med­i­cal scheme from those avail­able to you and then choos­ing a plan, or op­tion, of­fered by the scheme that fits in with both what you can af­ford and the level of health care you need is likely to leave you con­fused. Not only are many of­fer­ings by the med­i­cal schemes highly com­plex, but myr­iad dif­fer­ences make them dif­fi­cult to com­pare.

The an­nual GTC Med­i­cal Aid Sur­vey does much of the hard work for you by analysing and rat­ing med­i­cal schemes and pro­vid­ing a stan­dard­ised comparison and rank­ing of the choices avail­able to you – and the re­sults of the 2017 sur­vey have just been pub­lished.

GTC, for­merly Grant Thorn­ton Cap­i­tal, is a lead­ing fi­nan­cial ad­vi­sory busi­ness, es­tab­lished in 1991 from within the Grant Thorn­ton Jo­han­nes­burg au­dit prac­tice, it­self part of Grant Thorn­ton In­ter­na­tional.

The med­i­cal scheme sur­vey has been pro­duced an­nu­ally since 2011.

Jill Larkan, the head of health­care con­sult­ing at GTC, who is re­spon­si­ble for the sur­vey, says it “cuts through the no­to­ri­ously com­pli­cated land­scape of the med­i­cal aid in­dus­try and sim­pli­fies it ac­cord­ing to the fac­tors that mat­ter most when con­sumers choose a med­i­cal scheme and op­tion”.

Com­ment­ing on the 2017 sur­vey, Larkan says although smaller med­i­cal schemes are of­fer­ing good value for money, they have not been as suc­cess­ful as some of the larger schemes in at­tract­ing new mem­bers, which is es­sen­tial for the fi­nan­cial health of the scheme over the long term.

This year’s sur­vey re­viewed 23 open med­i­cal schemes and one closed (lim­ited-membership) scheme, with a to­tal of 144 op­tions, which fell into 11 cat­e­gories ac­cord­ing to the ben­e­fits of­fered. The cat­e­gories ranged from en­try-level and hospi­tal op­tions to saver and com­pre­hen­sive op­tions. Health­care poli­cies of­fered by insurance com­pa­nies were ex­cluded.

When you com­pare med­i­cal scheme of­fer­ings, you’re likely to con­cen­trate on value for money: what you get in re­turn for your monthly con­tri­bu­tion. But you also need to con­sider how fi­nan­cially Non-network healthy the scheme is, and how sus­tain­able it is into the fu­ture.

Both the value-for-money and the fi­nan­cial health as­pects are taken into ac­count in the sur­vey, which gives each op­tion a mi­cro rat­ing (in­di­cat­ing an op­tion’s value-for­money com­pet­i­tive­ness in re­la­tion to oth­ers in the same cat­e­gory) and a macro rat­ing (which con­sid­ers fac­tors such as membership size and growth, av­er­age age and fi­nan­cial sta­bil­ity).

“Fed­health is one of the schemes that has per­formed con­sis­tently well in the mi­cro ratings, in­di­cat­ing that it is very com­pet­i­tively priced and can of­fer con­sumers good value for money,” Larkan says.

Dis­cov­ery Health, the coun­try’s largest open scheme, came tops in the macro ratings.

The op­tions were fur­ther di­vided into network and non-network op­tions (those that con­fine mem­bers to a network of providers ver­sus those that let mem­bers freely choose their providers) and were rated ac­cord­ing to three types of membership: sin­gle, cou­ple (two adults) and fam­ily (two adults and two chil­dren).

The full sur­vey, which is avail­able at www. gtc. co. za, pro­vides de­tailed scor­ing and cost anal­y­sis, which is then sim­pli­fied by GTC’s “like­li­hood of sup­port” rat­ing of high, medium, or low, Larkan says. “This in­di­cates the like­li­hood of us rec­om­mend­ing a par­tic­u­lar plan, given the scores.”

The macro and mi­cro rank­ings com­bine to cre­ate GTC’s over­all list of schemes ranked by “like­li­hood of sup­port” (see table).

Larkan says: “The list re­flects the over­all best-scor­ing plans in our com­par­isons across all sec­tors. This is by no means a de­fin­i­tive or fi­nal rat­ing, as ‘soft’ fac­tors, such as ex­ist­ing ser­vic­ing re­la­tion­ships, past ex­pe­ri­ence, ad­min­is­tra­tion abil­ity, and cus­tomer service, have not been taken into ac­count.”

martin.hesse@inl.co.za

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