Medical Aids too expensive, say members

June 14, 2011

Findings from the 2010 OMAC Actuaries & Consultants Healthcare Monitor released in Johannesburg today reveal that due to a lack of awareness of their options, members generally feel their medical schemes are too expensive.

The survey comprised 1002 face-to-face interviews with members or beneficiaries who are significantly involved in decision-making regarding healthcare expenditure in the household, revealed that three quarters of respondents felt that their medical schemes were too expensive.

Margaret Hulme, Head of Healthcare Consulting at OMAC Actuaries & Consultants, says that this is probably because many members are on too rich an option for their benefit needs. “It seems that members are adopting a ‘rather safe than sorry’ approach when selecting medical schemes and options, instead of trying to improve their understanding. This would exacerbate the feeling that medical schemes are expensive,” she says.

Furthermore, cost-saving initiatives by schemes, particularly the introduction of Designated Service Providers (DSPs), actually have a negative effect on member perceptions of the scheme. Hulme says the current direction taken by schemes to control costs is to introduce more controls, e.g. the appointment of DSPs. This could be detrimental to schemes unless they can alter member perception in this regard. “Members do not like DSPs. This is not because of any problem with the concept itself, but rather owing to the perceived lack of freedom of choice – particularly when it comes to GPs.”

Hulme explains that although 84% of members believe that their scheme offers good value for money, they also believe that more expensive options with more benefits and without DSPs are providing the best value for money. This is in spite of the rich set of PMBs that must, by law, be provided by all schemes and benefit options.

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