SA Medical Schemes Fall Short of Expectations

December 15, 2021

A recent South African Consumer Satisfaction Index (SAcsi) survey says that SA medical schemes do not meet customer expectations.

The study was carried out in 2014 from a sample of just over 3,000 medical aid members. Even the highest scoring medical aid provider, Bonitas, only managed a score of 75.9 out of 100.

Other firms in the 74 regions were GEMS and Discovery Health. Medihelp had a score of 73.4, putting it just below the industry average of 74.1. Further below in the rankings were Liberty Health which scored 71.1 and Momentum Health which managed 69.6 out of 100.

The schemes that participated in the survey were chosen based on their market share. Each firm contributed at least 298 respondents to the survey.

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Most Members of A Medical Aid Plan Find SA Medical Schemes Fall Short of Expectations

The CEO of Consulta Research and SACsi founder Adre Schreuder surmises that none of the country’s medical schemes member expectation. He said schemes need to pull up their socks and boost both the actual and perceived value of their products.

Liberty and Momentum  scored below the industry average. Schreuder hinted that the problem could be how people perceive their offerings.

That could be why they have both dropped in the index as compared to the previous year. By contrast, Medihelp climbed by 2.4 points and Discovery by 2.1. And these scores indicate concerted efforts in improving the perception of their brand.

SA Medical Schemes Categories

Besides brands, the survey also looked at schemes according to categories – comprehensive, hospital plans and network schemes. The index indicated that network schemes had the poorest perception among policyholders regarding value for money.

Schreuder suggested the lack of understanding surrounding the concept of co-payments could be a factor in the low ranking of network plans in the survey. Comprehensive and hospital plans, however, enjoy a favourable perception among their customers.

SA Medical Schemes Claims Payment Record

Another factor in the little confidence in the value subscribers to SA medical schemes feel they’re getting for the premiums they pay is their first-hand experience with their chosen medical aid providers, especially when it comes to claims.

There are many complaints regarding the non-payment of claims by SA medical schemes, especially where it comes to the treatment of conditions listed under prescribed minimum benefits or PMBs.

Many members of SA medical schemes complain of having to pay for treatment out of pocket as schemes seek to manoeuvre their way out of paying. They use literal interpretations of the PMBs regulations as prescribed in the Medical Schemes Act to avoid making payouts to frustrated patients.

It is for this reason Section 27 is calling on policyholders with SA medical schemes who have endured such experiences to share them with the Competition Commission’s inquiry into the country’s private healthcare sector.

The aim of the inquiry is to figure out a way for South Africans to enjoy better accessibility to private healthcare at a price they can afford. Section 27’s lawyers are therefore calling on scheme members to help this process with their testimonies.

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All info was correct at time of publishing