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 |
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PLATINUM HEALTH MEDICAL SCHEME |
77 |
|
PROFMED MEDICAL SCHEME |
79 |
|
SAMWU NATIONAL MEDICAL SCHEME |
81 |
|
SASOLMED MEDICAL SCHEME |
83 |
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SOUTH AFRICAN POLICE SERVICE MEDICAL SCHEME |
85 |
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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 |