SA Medical Schemes Fall Short of Expectations

December 16, 2021

The ever-increasing cost of premiums, coupled with shrinking benefits, has been blamed for the downward spiral of confidence by consumers in the South African medical aid schemes industry.

Now in its sixth year, the SA-csi for Medical Schemes has released statistics for 2018. And these statistics clearly illustrate a growing lack of confidence by consumers who face yet another round of price in the year ahead. There is a growing feeling of dissatisfaction in an industry perceived to be delivering a diminishing-value product in comparison to those offered by other financial services.

Insight into medical aid schemes

This impartial insight into medical schemes is based on customer satisfaction measurements on a scale of 0 to 100. The 2018 poll reveals a drop in consumer confidence levels from 74.2 in 2017 down to 72.7 in 2018.

The decline has primarily been blamed on declining scores attributed to two of the medical aid scheme giants – Discovery Health and Bonitas. Discovery dropped from 74.8 to 73.1 and Bonitas from 73.1 to 70.2 over a 12-month period.

According to Professor AdréSchreuder, CEO of Consulta – a customer experience research company – a shift in perceptions towards pack leader, Discovery Health, can be attributed to the fact that it is changing its focus to other business areas such as banking services. This has opened the door for competitors to streamline their medical insurance offerings at more attractive costing structures, says Schreuder.

Medihelp takes the lead

Medihelp was the only medical aid company able to improve its SA-csi score, building on its continual improvement record since 2015 and becoming the industry leader in customer satisfaction. Medihelp’s customer satisfaction score has grown from 70.7 in 2015 to 75.1 in 2018.

Another noteworthy exception in the downward spiral of customer satisfaction is Momentum Health that managed to maintain its SA-csi score of 72.0 in both 2017 and 2018.

NHI will have a major impact

Another major impact on the South African medical aid industry is the pending introduction of a National Health Insurance (NHI) scheme that will open the door to improved medical services for all South Africans and not just for the privileged few who can afford to pay for medical aid products.

The NHI and Medical Schemes Amendment Bill was announced in June by the Minister of Health, Aaron Motsoaledi. Concerns are growing that the implementation of the Bill will add pressure to further increases in monthly medical aid premiums in 2019, while service providers will have to find solutions to improve their product range to negate higher levels of customer dissatisfaction. According to Schreuder, the medical scheme industry will have to focus their attention on quality, affordability and transparency.

Trends in medical aid

Professor Schreuder says South African medical aid service providers have displayed a trend over the years of focussingon internal organisation instead of customer delivery. On the other hand, a medical aid service provider like Medihelp that has focussed its attention on leveraging contributions and product delivery is exactly what consumers want and is displayed in the company’s growing customer satisfaction ratings.

Medical aid premiums increased above the inflation rate in 2018 by an average of nine per cent and Schreuder blames the cost of unnecessary medical treatments and hospital admissions for these spiralling premium costs.

SA-csi score results

The SA-csi index was based on a sample survey of 1,675 respondents randomly selected from five major medical aid schemes.

The 2018 scores for the five medical schemes selected for the survey are:

  • Bonitas – 70.2
  • Discovery – 73.1
  • GEMS – 68.8
  • Medihelp – 75.1
  • Momentum – 72


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All info was correct at time of publishing