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Medical Aid Funding
BY Carole Veitch
South Africa
28 January 2019
R 14 400.00 (ZAR)  
estimated $ 1 026.30 (USD) *
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Medical Aid Funding


The South African medical aid funding industry provides cover to over 8.8 million beneficiaries whose gross contributions amounted to R179.8bn in 2017. The total number of registered medical schemes declined from 124 in 2006 to 80 at end-March 2018. Discovery Health is the dominant player with over 2.7 million beneficiaries or around 31% of the total domestic market and over 50% of the open medical schemes segment. The Government Employees Medical Scheme dominates the restricted medical schemes segment with a market share of 47%. Medical scheme membership remains out of the reach of over 83% of the South African population.


Changes Ahead


The Competition Commission’s health market enquiry and the National Health Insurance (NHI) Bill and the Medical Schemes Amendment Bill are set to shake up the public and private healthcare systems. The medical aid funding industry is characterised by consolidation, contracting medical scheme benefits and rising gross monthly contributions per beneficiary. The industry faces numerous challenges including slowing membership growth and rising healthcare costs.


Report Coverage


The Medical Aid Funding Report describes the industry, major players and recent trends. It examines the initial Competition Commission findings and new legislation and factors influencing the sector’s success. It provides comprehensive profiles of 31 medical schemes and fund administrators including the major players in the private and public sector and smaller schemes such as Keyhealth and the Chartered Accountants Medical Aid Fund.


Page
1. INTRODUCTION 1
2. DESCRIPTION OF THE INDUSTRY 1
2.1. Value Chain 3
2.2. Geographic Position 5
3. SIZE OF THE INDUSTRY 6
4. STATE OF THE INDUSTRY 9
4.1. Local 9
4.1.1. Corporate Actions 14
4.1.2. Regulations 15
4.1.3. Enterprise Development and Social Economic Development 17
4.2. Continental 19
4.3. International 20
5. INFLUENCING FACTORS 22
5.1. Economic Environment 22
5.2. Government Interventions 22
5.3. Input Costs 23
5.4. Commercial Health Insurance 25
5.5. Fraud 25
5.6. Technology, Research and Development (R&D) and Innovation 25
5.7. Labour Resources 27
5.8. Environmental Concerns 28
5.9. Cyclicality 29
6. COMPETITION 30
6.1. Barriers to Entry 31
7. SWOT ANALYSIS 32
8. OUTLOOK 33
9. INDUSTRY ASSOCIATIONS 33
10. REFERENCES 34
10.1. Publications 34
10.2. Websites 34
APPENDIX 1 - SUMMARY OF NOTABLE PLAYERS 36
Major Open Medical Schemes 36
Major Restricted Medical Schemes 37
Major Medical Fund Administrators 38
APPENDIX 2 39
Registered Medical Schemes as at 31 March 2018 39
PROFILES OF NOTABLE OPEN MEDICAL SCHEMES 40
BESTMED MEDICAL SCHEME 40
BONITAS MEDICAL FUND 43
DISCOVERY HEALTH MEDICAL SCHEME 46
FEDHEALTH MEDICAL SCHEME 48
KEYHEALTH MEDICAL SCHEME 50
MEDIHELP MEDICAL SCHEME 52
MEDSHIELD MEDICAL SCHEME 54
MOMENTUM HEALTH 56
SIZWE MEDICAL FUND 58
PROFILES OF NOTABLE RESTRICTED MEDICAL SCHEMES 61
ANGLO MEDICAL SCHEME 61
BANKMED MEDICAL SCHEME 63
CHARTERED ACCOUNTANTS MEDICAL AID FUND 65
GOVERNMENT EMPLOYEES MEDICAL SCHEME 67
LA-HEALTH MEDICAL SCHEME 71
MOTO HEALTH CARE 73
NEDGROUP MEDICAL AID SCHEME 75
PLATINUM HEALTH MEDICAL SCHEME 77
PROFMED MEDICAL SCHEME 79
SAMWU NATIONAL MEDICAL SCHEME 81
SASOLMED MEDICAL SCHEME 83
SOUTH AFRICAN POLICE SERVICE MEDICAL SCHEME 85
TRANSMED MEDICAL FUND 87
PROFILES OF NOTABLE MEDICAL FUND ADMINISTRATORS 89
AGILITY HOLDINGS (RF) (PTY) LTD 89
DISCOVERY HEALTH (PTY) LTD 91
MEDSCHEME HOLDINGS (PTY) LTD 94
METROPOLITAN HEALTH CORPORATE (PTY) LTD 97
MMI HEALTH (PTY) LTD 99
MOMENTUM THEBE YA BOPHELO (PTY) LTD 101
PROFESSIONAL PROVIDENT SOCIETY HEALTHCARE ADMINISTRATORS (PTY) LTD 103
SECHABA MEDICAL SOLUTIONS (PTY) LTD 105
UNIVERSAL HEALTHCARE ADMINISTRATORS (PTY) LTD 107