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    medical aid funding industry south africa

    The Medical Aid Funding Industry in South Africa 2022

    Yasmin Mahomedy | South Africa | 31 October 2022

    The Medical Aid Funding Industry in South Africa 2020

    Rebecca Viljoen | South Africa | 10 November 2020

    The Medical Aid Funding Industry in South Africa 2019

    Carole Veitch | South Africa | 28 January 2019

    The Medical Aid Funding Industry in South Africa 2016

    Carole Veitch | South Africa | 11 April 2016

    The Medical Aid Funding Industry in South Africa 2014

    Carole Veitch | South Africa | 30 October 2014

    Report Info

    Report Summary Table of Contents
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    Report Coverage

    This report on medical aid funding in South Africa includes information on the effects of the pandemic and recovery, membership and claims trends and the development of the NHI. There are profiles of 30 companies including the major government scheme GEMS and major private sector players such as Discovery, Momentum and Bonitas.

    Introduction

    • South Africa has a two-tiered, and highly unequal, healthcare system, with more than 80% of the population being state-funded.
    • While only 14.86% of the population can afford private healthcare, the high costs are making it increasingly difficult for some people to continue.
    • Government plans to implement National Health Insurance with most of the funding coming from general taxes and contributions of people earning above a set amount.
    • The process, which began in August 2011, has been slow, and the NHI Bill is still under consideration in the National Assembly.
    • The private sector has raised concerns about its affordability, and the state’s ability to implement it effectively and competently.

    Strengths

    • Managed care programmes that predict and prevent lifestyle diseases.
    • Medical schemes are required to have a non-discriminatory membership base.
    • The industry is well-established.
    • The industry supports the private healthcare system and takes pressure off public healthcare.
    • The shortcomings of public healthcare strengthen demand for schemes.

    Weaknesses

    • Fraud, waste, and abuse is pervasive.
    • High expenditure for scheme members.
    • Industry is constrained by regulatory uncertainty.
    • Premiums are high and membership remains unaffordable for most South Africans.
    • The complexity of schemes and benefit plans makes it difficult for individuals to fully understand their options and make informed decisions. This affects competition.

    Opportunities

    • Attracting younger members.
    • Designing affordable benefit plans.
    • Evolving care models, including predictive and preventative care.
    • Online consultations and virtual care technologies (telehealth).
    • Shortcomings of public health system create an ongoing need for medical aid.
    • The phasing-in of the NHI offers opportunities for private-public collaboration.

    Threats

    • Cost pressures and significant increases in medical aid contributions.
    • Economic uncertainty.
    • Fraud, waste, and abuse
    • High levels of unemployment and low salary increases.
    • NHI Fund eventually causing medical schemes to be obsolete and/or significant loss in membership.
    • Regulatory uncertainty around the NHI.
    • The impacts of climate change on the sustainability of the healthcare and medical aid funding sectors.
    • The sector is vulnerable to domestic and global macroeconomic pressures.

    Outlook

    • The downward trend in the number of registered medical schemes over the past years is expected to continue as more small schemes amalgamate with bigger schemes.
    • South Africa’s economic challenges will mean fewer households will be able to afford private healthcare.
    • Although private healthcare showed resilience over the past two years, medical schemes will have to manage debt and keep membership costs affordable.
    • Many scheme members cannot afford above-inflation increases and are looking for alternative ways of funding their access to private healthcare.

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    The Medical Aid Funding Industry in South Africa
    The Medical Aid Funding Industry in South Africa 2022

    Full Report

    R 6 500.00(ZAR) estimated $366.35 (USD)*

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    Industry Landscape

    R 4 550.00(ZAR) estimated $ 256.44 (USD)*

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    Historical Reports

    The Medical Aid Funding Industry in South Africa 2020-11-10

    R 1 900.00(ZAR) estimated $107.09 (USD)*

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    The Medical Aid Funding Industry in South Africa 2019-01-28

    R 1 900.00(ZAR) estimated $107.09 (USD)*

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    The Medical Aid Funding Industry in South Africa 2016-04-11

    R 1 900.00(ZAR) estimated $107.09 (USD)*

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    The Medical Aid Funding Industry in South Africa 2014-10-30

    R 1 900.00(ZAR) estimated $107.09 (USD)*

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    Table of Contents

    [ Close ]
    PAGE
    1. INTRODUCTION 1
    2. DESCRIPTION OF THE INDUSTRY 1
    2.1. Industry Value Chain 4
    2.2. Geographic Position 5
    2.3. Size of the Industry 6
    3. LOCAL 10
    3.1. State of the Industry 10
    3.2. Key Trends 16
    3.3. Key Issues 17
    3.4. Notable Players 18
    3.5. Corporate Actions 22
    3.6. Regulations 23
    3.7. Enterprise Development and Social Development 24
    4. AFRICA 25
    5. INTERNATIONAL 27
    6. INFLUENCING FACTORS 29
    6.1. COVID-19 29
    6.2. Economic Environment 31
    6.3. Input Costs 33
    6.4. Fraud, Waste, and Abuse 34
    6.5. Labour 34
    6.6. Environmental Issues 35
    6.7. Technology, R&D, Innovation 36
    6.8. Government Interventions 37
    7. COMPETITIVE ENVIRONMENT 38
    7.1. Competition 38
    7.2. Ownership Structure of the Industry 41
    7.3. Barriers to Entry 41
    8. SWOT ANALYSIS 42
    9. OUTLOOK 43
    10. INDUSTRY ASSOCIATIONS 43
    11. REFERENCES 43
    11.1. Publications 43
    11.2. Websites 44
    APPENDIX 1 - SUMMARY OF NOTABLE PLAYERS 45
    Major Open Medical Schemes 45
    Major Restricted Medical Aids 46
    Major Medical Fund Administrators 48
    COMPANY PROFILES - MAJOR OPEN MEDICAL SCHEMES 49
    Bestmed Medical Scheme 49
    Bonitas Medical Fund 52
    Discovery Health Medical Scheme 55
    Fedhealth Medical Scheme 57
    KeyHealth Medical Scheme 59
    Medihelp Medical Scheme 61
    Medshield Medical Scheme 63
    Momentum Health 65
    Sizwe Hosmed Medical Scheme 67
    COMPANY PROFILES - MAJOR RESTRICTED MEDICAL AIDS 70
    Anglo Medical Scheme 70
    Bankmed Medical Scheme 72
    Chartered Accountants Medical Aid Fund 74
    Government Employees Medical Scheme 76
    LA-Health Medical Scheme 79
    Moto Health Care 81
    Platinum Health Medical Scheme 83
    Profmed Medical Scheme 85
    SAMWU National Medical Scheme 87
    Sasolmed Medical Scheme 89
    South African Police Service Medical Scheme 90
    Transmed Medical Fund 92
    COMPANY PROFILES - MAJOR MEDICAL FUND ADMINISTRATORS 94
    3Sixty Health (Pty) Ltd 94
    Agility Holdings (RF) (Pty) Ltd 96
    Discovery Health (Pty) Ltd 98
    Medscheme Holdings (Pty) Ltd 101
    Metropolitan Health Corporate (Pty) Ltd 104
    Momentum Health Solutions (Pty) Ltd 106
    Momentum Thebe Ya Bophelo (Pty) Ltd 108
    Professional Provident Society Healthcare Administrators (Pty) Ltd 110
    Universal Healthcare Administrators (Pty) Ltd 112

    Report Coverage

    This report focuses on Medical Aid Funding, and includes information on the state and size of the sector, developments and corporate actions of its major players, and influencing factors including regulation and the effect of the coronavirus pandemic. There are profiles of 31 companies including major administrators such as Discovery Health, Medscheme and Momentum Health, restricted schemes such as the Government Employees Medical Scheme, South African Police Service Medical Aid and Sasolmed, and open schemes such as Bestmed and Medshield.

    Introduction

    The South African medical aid funding industry provides cover to some 8.8 million beneficiaries. South Africa spends more on private health insurance as a percentage of total health expenditure than almost any other country. In 2018, gross contributions amounted to R192.28bn and total healthcare expenditure paid out in benefits totalled R173.3bn. Although the sector performs a critical role in the country’s health system, medical scheme membership remains out of the reach of over 85% of the population. Although the details remain unclear, the implementation of the National Health Insurance (NHI) Fund will invariably impact the public and private healthcare systems, including the medical aid funding sector. The findings of the Competition Commission’s Health Market Inquiry call for measures to improve competition and transparency in the medical aid funding industry. Medical schemes are under significant pressure in the context of a low growth market where member expectations and utilisation are high - and rising. Meanwhile, the complexity of the industry and members’ low price tolerance is translating into a decrease in loyalty. South Africa’s poor economic performance has augmented the trend of members cutting costs by downgrading their benefit options without readjusting expectations.

    Strengths

    • Managed care programmes that predict and prevent lifestyle diseases.
    • Medical schemes are required to have a sound, non-discriminatory membership base.
    • The industry is client-centric.
    • The industry is well-established, with a lot of institutional knowledge.
    • The medical aid funding industry supports the private healthcare system and takes pressure off public healthcare.
    • The shortcomings of public healthcare strengthen demand for schemes.

    Weaknesses

    • Consistently low consumer satisfaction.
    • Fraud, waste and abuse is pervasive in the medical scheme environment.
    • Medical scheme premiums are high and membership remains unaffordable for most South Africans.
    • Membership is ageing.
    • Out-of-pocket expenditure of scheme members exceeds the benchmark figure of 15% proposed by the World Health Organisation.
    • The complexity of schemes and benefit plans makes it difficult for individuals to fully understand their options and make informed decisions. This impacts on competition.
    • The industry is constrained by regulatory uncertainty and existing regulations are widely viewed as being complex and inflexible.
    • There is a lack of authentic competition.

    Opportunities

    • Attracting younger members.
    • Data management, analytics and behavioural change models can help tailor individual healthcare services and encourage healthy lifestyle choices.
    • Designing affordable benefit options.
    • Developing easier to understand products and improving communication.
    • Evolving care models, including predictive and preventative care.
    • Growing expectations amongst stakeholders with regards to corporate accountability and purpose-driven business.
    • mHealth innovation to offer medical aid funding to remote and low-income households.
    • Online consultations and virtual care technologies (tele-health).
    • Shortcomings of public health system create an ongoing need for medical aid.
    • Technology can improve the reach and efficiency of healthcare services.
    • The emerging middle class represents a valuable pool of potential members.
    • The medical scheme industry in the SADC region, especially through government- and employer-subsidised programmes.
    • The phasing-in of the NHI offers opportunities for private-public collaboration.

    Threats

    • Banning of low-cost benefit options.
    • Cost pressures and significant increases in medical aid contributions.
    • Disempowered medical scheme trustees.
    • Fraud, waste and abuse, including cybercrime.
    • Historic distrust between the public and private health sectors.
    • Overregulation and regulatory uncertainty, including uncertainty around the NHI.
    • Political and economic uncertainty.
    • Poor economic performance, made worse by coronavirus. High levels of unemployment and low salary increases.
    • Regulatory changes may require companies to take on more risk, resulting in increased premiums.
    • Run-away medical inflation.
    • The impacts of climate change on the sustainability of the healthcare and medical aid funding sectors.
    • The NHI Fund eventually causing medical schemes to be obsolete and/or significant loss in membership.
    • The sector is vulnerable to domestic and global macroeconomic pressures.

    Outlook

    The South African economy is in recession, and the coronavirus pandemic has negatively affected the global outlook for 2020 and 2021, the full implications of which are still unknown. Against the backdrop of rising premiums and a struggling economy, the trend of low membership growth and members downgrading their benefits is likely to continue, and the medical aid funding industry is likely to keep consolidating. Medical schemes will be forced to innovate, with models such as behaviour change and shared-value insurance performing well. The financial sustainability of schemes will in part depend on each scheme’s ability to innovate with benefit design and cross-subsidise through attracting and retaining younger and healthier members. Technological innovation will increasingly become an imperative, as online platforms are used to administer scheme-related and healthcare services. Data analytics is likely to become more sophisticated and integrated into a member’s experience of their plan; monitoring, analysing and managing a member’s health profile. Technological innovation also has the potential to develop financial service models that improve the accessibility and affordability of quality healthcare for low-income households. If there is the political will, the recommendations of the Health Market Inquiry may see more transparency in medical schemes and more standardisation across them, allowing individuals to better evaluate their options. While the roll-out of the NHI Fund appears to be a direct threat to the existence of medical schemes, it remains to be seen when and in what form NHI will be implemented. Providing universal health coverage for the whole population is a major undertaking and the state’s fiscal health may not be robust enough to deliver comprehensive healthcare to the extent that it displaces the demand for medical scheme membership.

    Read More..
    The Medical Aid Funding Industry in South Africa
    The Medical Aid Funding Industry in South Africa 2020

    Full Report

    R 1 900.00(ZAR) estimated $107.09 (USD)*

    Buy Now +

    Industry Landscape

    R 1 330.00(ZAR) estimated $ 74.96 (USD)*

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    Historical Reports

    The Medical Aid Funding Industry in South Africa 2022-10-31

    R 6 500.00(ZAR) estimated $366.35 (USD)*

    View Report Add to Cart

    The Medical Aid Funding Industry in South Africa 2019-01-28

    R 1 900.00(ZAR) estimated $107.09 (USD)*

    View Report Add to Cart

    The Medical Aid Funding Industry in South Africa 2016-04-11

    R 1 900.00(ZAR) estimated $107.09 (USD)*

    View Report Add to Cart

    The Medical Aid Funding Industry in South Africa 2014-10-30

    R 1 900.00(ZAR) estimated $107.09 (USD)*

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    Table of Contents

    [ Close ]
    PAGE
    1. INTRODUCTION 1
    2. DESCRIPTION OF THE INDUSTRY 1
    2.1. Industry Value Chain 5
    2.2. Geographic Position 8
    3. SIZE OF THE INDUSTRY 10
    4. STATE OF THE INDUSTRY 13
    4.1. Local 13
    4.1.1. Corporate Actions 20
    4.1.2. Regulations 20
    4.1.3. Enterprise Development and Socio-Economic Development 23
    4.2. Continental 24
    4.3. International 25
    5. INFLUENCING FACTORS 28
    5.1. Economic Environment 28
    5.2. Government Interventions and Regulations 29
    5.3. Population Health 32
    5.4. Coronavirus 33
    5.5. Input Costs 34
    5.6. Fraud, Waste and Abuse 35
    5.7. Research and Development (R&D), Technology and Innovation 36
    5.8. Labour 38
    5.9. Environmental Concerns 39
    5.10. Cyclicality 40
    6. COMPETITION 40
    6.1. Barriers to Entry 43
    7. SWOT ANALYSIS 44
    8. OUTLOOK 45
    9. INDUSTRY ASSOCIATION 46
    10. REFERENCES 47
    10.1. Publications 47
    10.2. Websites 47
    APPENDIX 1 - SUMMARY OF NOTABLE PLAYERS 49
    Major Open Medical Schemes 49
    Major Restricted Medical Schemes 50
    Major Medical Fund Administrators 51
    PROFILES OF NOTABLE OPEN MEDICAL SCHEMES 53
    BESTMED MEDICAL SCHEME 53
    BONITAS MEDICAL FUND 56
    DISCOVERY HEALTH MEDICAL SCHEME 59
    FEDHEALTH MEDICAL SCHEME 61
    KEYHEALTH MEDICAL SCHEME 63
    MEDIHELP MEDICAL SCHEME 65
    MEDSHIELD MEDICAL SCHEME 67
    MOMENTUM HEALTH 69
    SIZWE MEDICAL FUND 71
    PROFILES OF NOTABLE RESTRICTED MEDICAL SCHEMES 73
    ANGLO MEDICAL SCHEME 73
    BANKMED MEDICAL SCHEME 75
    CHARTERED ACCOUNTANTS MEDICAL AID FUND 77
    GOVERNMENT EMPLOYEES MEDICAL SCHEME 79
    LA-HEALTH MEDICAL SCHEME 82
    MOTO HEALTH CARE 84
    NEDGROUP MEDICAL AID SCHEME 86
    PLATINUM HEALTH MEDICAL SCHEME 88
    PROFMED MEDICAL SCHEME 90
    SAMWU NATIONAL MEDICAL SCHEME 92
    SASOLMED MEDICAL SCHEME 94
    SOUTH AFRICAN POLICE SERVICE MEDICAL SCHEME 95
    TRANSMED MEDICAL FUND 97
    PROFILES OF NOTABLE MEDICAL FUND ADMINISTRATORS 99
    3SIXTY HEALTH (PTY) LTD 99
    AGILITY HOLDINGS (RF) (PTY) LTD 101
    DISCOVERY HEALTH (PTY) LTD 103
    MEDSCHEME HOLDINGS (PTY) LTD 106
    METROPOLITAN HEALTH CORPORATE (PTY) LTD 109
    MOMENTUM HEALTH SOLUTIONS (PTY) LTD 111
    MOMENTUM THEBE YA BOPHELO (PTY) LTD 113
    PROFESSIONAL PROVIDENT SOCIETY HEALTHCARE ADMINISTRATORS (PTY) LTD 115
    UNIVERSAL HEALTHCARE ADMINISTRATORS (PTY) LTD 117

    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.\r\n

    Introduction

    The South African medical aid funding industry provides cover to over 8.8 million beneficiaries . In 2017, gross contributions amounted to R179.8bn and total healthcare expenditure totalled R160.6bn. Although the sector performs a critical role in the country’s health system, medical scheme membership remains out of the reach of over 83% of the South African population. Presenting the National Health Insurance (NHI) Bill and the Medical Schemes Amendment Bill to the media in June 2018, health minister Aaron Motsoaledi said that the draft legislation represented a massive shake-up for the public and private healthcare systems. Meanwhile, the medical aid funding industry remains in a state of flux as it awaits the definitive findings of the Competition Commission’s health market inquiry.

    Strengths

    • Medical schemes are required to have a sound, non-discriminatory membership base.
    • The industry is client-centric.
    • The industry is well-established.
    • The South African medical aid funding industry supports the private healthcare system.

    Weaknesses

    • Fraud is pervasive in the medical scheme environment.
    • Medical scheme premiums are high and scheme membership remains beyond the reach of more than 83% of South Africa’s population.
    • Out-of-pocket expenditure of scheme members exceeds the benchmark figure of 15% proposed by the World Health Organisation.
    • The industry is constrained by regulatory uncertainty and existing regulations are widely viewed as being complex and inflexible.
    • There is a lack of authentic competition.

    Opportunities

    • Designing benefit options that are more affordable.
    • The emerging middle class represents a valuable pool of potential members.
    • The medical scheme industry in the SADC region offers many opportunities, especially through government-subsidised or employer-subsidised programmes.
    • The phasing-in of the NHI offers opportunities for private-public collaboration.

    Threats

    • Climate change represents a substantial threat to the sustainability of the healthcare and medical aid funding sectors.
    • Regulatory changes may require companies to take on more risk, resulting in increased premiums.
    • Run-away medical inflation poses a threat to the sustainability of medical schemes.
    • The implementation of the NHI could result in a decline in scheme membership.
    • The sector is vulnerable to domestic and global macroeconomic pressures.

    Outlook

    With open medical scheme contribution increases for 2019 averaging around 10.3% and medical tax deductions shrinking, South Africa’s medical scheme members are likely to remain under pressure. Given the ever-rising cost of medical aid premiums, coupled with the weak macroeconomic environment, role players do not anticipate meaningful membership growth in the short-term. Medical scheme consolidation is expected to continue, as role players endeavour to restructure. Although some role players are apprehensive about the proposed regulatory changes and the possibility of having to take on more risk, others say that policy interventions will ultimately strengthen the sustainability of South Africa’s medical aid funding industry.

    Read More..
    The Medical Aid Funding Industry in South Africa
    The Medical Aid Funding Industry in South Africa 2019

    Full Report

    R 1 900.00(ZAR) estimated $107.09 (USD)*

    Buy Now +

    Industry Landscape

    R 1 330.00(ZAR) estimated $ 74.96 (USD)*

    Buy Now +

    Historical Reports

    The Medical Aid Funding Industry in South Africa 2022-10-31

    R 6 500.00(ZAR) estimated $366.35 (USD)*

    View Report Add to Cart

    The Medical Aid Funding Industry in South Africa 2020-11-10

    R 1 900.00(ZAR) estimated $107.09 (USD)*

    View Report Add to Cart

    The Medical Aid Funding Industry in South Africa 2016-04-11

    R 1 900.00(ZAR) estimated $107.09 (USD)*

    View Report Add to Cart

    The Medical Aid Funding Industry in South Africa 2014-10-30

    R 1 900.00(ZAR) estimated $107.09 (USD)*

    View Report Add to Cart

    Table of Contents

    [ Close ]
    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

    Report Coverage

    The report on the medical aid funding sector describes the current market, the latest regulatory developments and discusses factors influencing the success of the sector. The report profiles nine medical fund administrators and 23 medical aid companies including market leader, Discovery Health which increased its market share in the open medical schemes segment from 52.4% in 2013 to 53.4% in 2014, and the Government Employees’ Medical Scheme (GEMS), the largest of the restricted medical schemes.

    Introduction

    This report focuses on South Africa’s medical aid funding industry. The sector, which comprises 83 registered medical schemes, currently serves almost 8.8 million beneficiaries. With scheme contributions and healthcare expenditure for the financial year ending 31 March 2015 amounting to R140.2bn and R124.1bn respectively, the industry plays a critical role in South Africa’s private health sector, which is currently the subject of a Competition Commission inquiry. Addressing the media on the first day of the Competition Commission’s public hearings on the matter, Minister of Health, Dr. Aaron Motsoaledi, called for an overhaul of South Africa’s private healthcare system. The Health Minister lambasted the medical aid funding industry, stating that “the behaviour of medical aid schemes was a symptom of a big malady.\"

    Strengths

    • It seeks to remain at the forefront of innovative technological development.
    • South African medical schemes are required to have a sound, non-discriminatory membership base.
    • The industry is client-centric and strives to deliver service of a high standard.
    • The industry is robust, stable and competitive.
    • The medical aid funding industry supports South Africa’s private healthcare system.

    Weaknesses

    • Medical scheme premiums are high and scheme membership remains beyond the reach of more than 80% of South Africa’s population.
    • Out-of-pocket expenditure of South African medical scheme members exceeds the benchmark figure of 15% proposed by the WHO.
    • Schemes have been precluded from offering more affordable lower-cost options, by virtue of the requirement to include PMBs in all benefit options.
    • The absence of a standardised reference price list drives medical expenditure higher.
    • The industry is constrained by regulatory uncertainty. Existing regulations are widely viewed as being complex and inflexible.

    Opportunities

    • The demarcation process that is currently underway provides opportunities for schemes to increase their membership, particularly if they are able to design options that are more affordable.
    • The emerging middle class represents a valuable pool of potential members.
    • The medical scheme industry in Africa offers many opportunities, especially through government subsidised or employer subsidised programmes.
    • The phasing-in of the NHI offers opportunities for private-public collaboration.

    Threats

    • Climate change represents a substantial threat to the sustainability of both the healthcare and medical aid funding sectors.
    • Spiralling costs threaten the sustainability of smaller schemes.
    • The sector is vulnerable to both domestic and global economic pressures.

    Outlook

    Notwithstanding the prevailing ‘winds of change’ that continue to disrupt the medical aid funding industry, stakeholders generally remain confident that the sector will remain resilient and stable. However, the growth prospects of the industry are expected to remain subdued over the next three years, pending the outcome of the Competition Commission inquiry and the implementation of proposed regulatory reforms. With the phasing-in of the NHI, several stakeholders in the private healthcare sector are hoping to capitalise on potential opportunities. However, some analysts fear that medical scheme membership could be eroded when the NHI is formally implemented. Despite the current climate of uncertainty, many stakeholders are optimistic about the long-term prospects of the industry. Of particular interest is the CMS’s recent proposal relating to the proposed development of affordable medical scheme benefit options for low-income earners.

    Read More..
    The Medical Aid Funding Industry in South Africa
    The Medical Aid Funding Industry in South Africa 2016

    Full Report

    R 1 900.00(ZAR) estimated $107.09 (USD)*

    Buy Now +

    Industry Landscape

    R 1 330.00(ZAR) estimated $ 74.96 (USD)*

    Buy Now +

    Historical Reports

    The Medical Aid Funding Industry in South Africa 2022-10-31

    R 6 500.00(ZAR) estimated $366.35 (USD)*

    View Report Add to Cart

    The Medical Aid Funding Industry in South Africa 2020-11-10

    R 1 900.00(ZAR) estimated $107.09 (USD)*

    View Report Add to Cart

    The Medical Aid Funding Industry in South Africa 2019-01-28

    R 1 900.00(ZAR) estimated $107.09 (USD)*

    View Report Add to Cart

    The Medical Aid Funding Industry in South Africa 2014-10-30

    R 1 900.00(ZAR) estimated $107.09 (USD)*

    View Report Add to Cart

    Table of Contents

    [ Close ]
    PAGE
    1. INTRODUCTION 1
    2. DESCRIPTION OF THE INDUSTRY 1
    2.1. Value Chain 3
    2.2. Geographic Position 4
    3. SIZE OF THE INDUSTRY 6
    4. STATE OF THE INDUSTRY 11
    4.1. Local 11
    4.1.1. Corporate Actions 15
    4.1.2. Regulations 16
    4.1.3. Enterprise Development and Socio-Economic Development Initiatives 19
    4.2. Continental 21
    4.3. International 22
    5. INFLUENCING FACTORS 24
    5.1. Economic Environment 24
    5.2. Government Intervention 25
    5.3. Input Costs 26
    5.4. Commercial Health Insurance 28
    5.5. Managed Health Care 28
    5.6. Technology, Research and Development (R&D) and Innovation 29
    5.7. Labour Resources 31
    5.8. Environmental Concerns 33
    5.9. Cyclicality 34
    6. COMPETITION 35
    6.1. Barriers to Entry 36
    7. SWOT ANALYSIS 37
    8. OUTLOOK 38
    9. INDUSTRY ASSOCIATIONS 39
    10. REFERENCES 39
    10.1. Publications 39
    10.2. Websites 40
    APPENDIX 1 42
    Registered Medical Schemes – 2014/2015 42
    APPENDIX 2 44
    Medical Scheme Administrators 44
    APPENDIX 3 45
    Managed Care Organisations (MCOs) – 2014/2015 45
    COMPANY PROFILES – OPEN MEDICAL SCHEMES 48
    BESTMED MEDICAL SCHEME 48
    BONITAS MEDICAL FUND 51
    DISCOVERY HEALTH MEDICAL SCHEME 53
    FEDHEALTH MEDICAL SCHEME 56
    KEYHEALTH MEDICAL SCHEME 58
    LIBERTY MEDICAL SCHEME 60
    MEDIHELP MEDICAL SCHEME 62
    MEDSHIELD MEDICAL SCHEME 64
    MOMENTUM HEALTH 66
    SIZWE MEDICAL FUND 68
    SPECTRAMED MEDICAL SCHEME 70
    COMPANY PROFILES – RESTRICTED MEDICAL SCHEMES 72
    BANKMED MEDICAL SCHEME 72
    CHARTERED ACCOUNTANTS MEDICAL AID FUND 74
    GOVERNMENT EMPLOYEES MEDICAL SCHEME 76
    LA-HEALTH MEDICAL SCHEME 79
    MOTO HEALTH CARE 81
    NEDGROUP MEDICAL AID SCHEME 83
    PLATINUM HEALTH 85
    PROFMED MEDICAL SCHEME 87
    SAMWU NATIONAL MEDICAL SCHEME 89
    SASOLMED MEDICAL SCHEME 92
    SOUTH AFRICAN POLICE SERVICE MEDICAL SCHEME 94
    TRANSMED MEDICAL SCHEME 96
    COMPANY PROFILES – FUND ADMINISTRATORS 98
    AGILITY HOLDINGS (RF) (PTY) LTD 98
    DISCOVERY HEALTH (PTY) LTD 100
    MEDSCHEME LTD 103
    METROPOLITAN HEALTH CORPORATE (PTY) LTD 106
    MMI HEALTH (PTY) LTD 108
    PROFESSIONAL PROVIDENT SOCIETY HEALTHCARE ADMINISTRATORS (PTY) LTD 110
    PROVIDENCE HEALTHCARE RISK MANAGERS (PTY) LTD 111
    SECHABA MEDICAL SOLUTIONS (PTY) LTD 113
    STRATA HEALTHCARE MANAGEMENT (PTY) LTD 115
    UNIVERSAL HEALTHCARE ADMINISTRATORS (PTY) LTD 117
    0

    Introduction

    This report focuses on a vital pillar of South Africa’s private healthcare sector, the South African medical aid funding industry. The sector, which currently comprises 85 registered medical schemes, serves 8,776,279 beneficiaries. In 2013, medical scheme membership contributions totalled R129.8bn, while medical schemes’ healthcare expenditure amounted to R112.9bn. The climate of regulatory uncertainty has been cited by stakeholders as a major challenge facing the sector. Although revised draft\nregulations released by National Treasury in April 2014 attempt to draw a clear line between the role of medical aids and that of medical insurance products, role players are yet to achieve consensus and the future of certain health insurance products remains in the balance. Other grave concerns include the threat posed by Ebola and the spiralling cost of healthcare. Speaking at the 15th Annual Board of Healthcare Funders of Southern Africa (BHF) Conference held in Durban in August 2014, Dr Anban Pillay, Deputy Director-General:\nHealth Regulatory and Compliance Management of the Department of Health, acknowledged that medical schemes and their members were facing considerable challenges in an environment where healthcare costs and the utilisation of services continued to increase.

    Strengths

    • It seeks to remain at the forefront of innovative technological development.
    • South African medical schemes are required to have a sound, non-discriminatory membership base.
    • The industry is robust, stable and competitive.
    • The sector supports South Africa’s private healthcare system.

    Weaknesses

    • Medical scheme premiums are not affordable and scheme\nmembership remains beyond the reach of more than 80%\nof South Africa’s population.
    • Schemes are precluded from offering more affordable\nlower-cost options, by virtue of the requirement to include PMBs in all benefit options.
    • The absence of a standardised reference price list drives medical expenditure higher.
    • The industry is constrained by regulatory uncertainty.\nExisting regulations are widely viewed as complex and inflexible.

    Opportunities

    • Penetration of the market is low. However, the emerging\nmiddle class represents a valuable pool of potential\nmembers.
    • The demarcation process that is currently underway\nprovides opportunities for schemes to increase their\nmembership, particularly if they
    • The medical scheme industry in Africa offers many\nopportunities, especially through government-subsidised\nor employer-subsidised programmes.
    • The phasing-in of the NHI offers opportunities for privatepublic\ncollaboration.

    Threats

    • Climate change represents a substantial threat to the sustainability of both the healthcare and medical aid funding sectors. The number of people requiring treatment\nfor illnesses and injuries associated with climate change could potentially increase substantially.
    • Spiralling costs threaten the sustainability of smaller schemes.
    • The sector is vulnerable to both domestic and global economic pressures.
    • The spread of the Ebola epidemic to South Africa could have a devastating effect on the medical aid industry.

    Outlook

    Although the prevailing climate of uncertainty has created a general sense of uneasiness in the medical aid funding industry, analysts believe that the outlook for the sector remains relatively stable in the short-term. However, they caution that growth will remain muted and that the consolidation trend will persist, as smaller schemes come under increasing pressure. Stakeholders in the medical schemes industry are optimistic that the proposed regulatory reforms will impact positively on the sector and that progress will be made with regard to key issues, which include the pricing of PMBs and the establishment of a pricing framework in the private healthcare sector. The phasing-in of the NHI programme presents multiple opportunities for public-private partnerships. While many players are cautiously optimistic, others are adopting a ‘wait-and-see’ approach. The uptake of eHealth and mHealth across sub-Saharan Africa is set to revolutionise healthcare on the continent. However, the shadow of Ebola looms large over the healthcare landscape and analysts warn that the epidemic, described by the WHO as “the most severe acute public health emergency seen in modern times,” could have a devastating impact on the global healthcare sector, as well as the medical aid funding industry.

    The Medical Aid Funding Industry in South Africa
    The Medical Aid Funding Industry in South Africa 2014

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    Table of Contents

    [ Close ]
    PAGE
    1. INTRODUCTION 1
    2. DESCRIPTION OF THE INDUSTRY 1
    2.1. Industry Supply Chain 2
    2.2. Geographic Position 3
    3. SIZE OF THE INDUSTRY 4
    4. STATE OF THE INDUSTRY 7
    4.1. Local 7
    4.1.1. Corporate Actions 9
    4.1.2. Regulations & Government Programmes 10
    4.1.3. Enterprise Development and Social Economic Development 12
    4.2. Continental 13
    4.3. International 14
    5. INFLUENCING FACTORS 15
    5.1. Government Intervention 15
    5.2. Economic Environment 16
    5.3. Rising Input Costs 16
    5.4. Commercial Health Insurance 17
    5.5. Managed Health Care 18
    5.6. Information Technology and Technology 18
    5.7. Implementation of NHI 19
    5.8. Labour 20
    5.9. Environmental Concerns 21
    6. COMPETITION 21
    6.1. Barriers to Entry 22
    6.2. Research and Development (R&D) and Innovation 23
    7. SWOT ANALYSIS 23
    8. OUTLOOK 24
    9. INDUSTRY ASSOCIATIONS 24
    10. REFERENCES 25
    10.1. Publications 25
    10.2. Websites 25
    APPENDIX 1 26
    Registered Medical Schemes 26

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