The number of people who can afford medical cover may drop further come 2017, as Insight Actuaries has reported that higher-than-usual contribution increases can be expected for the coming year.
A recent report by Global Credit Ratings (GCR) highlighted that the medical schemes reviewed (11 of South Africa’s top medical schemes including Discovery Health, Momentum Health, BestMed and Liberty Health) operated at a loss in 2015, but was cushioned by financial reserves going into 2016. However, the latest results reveal that again the medical schemes are operating at a loss.
As a result of this, Insight Actuaries have said that higher increases for the 2017 should be expected.
In a report on BDLive, Insight Actuaries joint CEO Christoff Raath*, said: “There appears to be general consensus in the industry that 2016 claims experience is higher than expected.
"Our impression at Insight is that this is an industry-wide phenomenon driven by higher utilisation rather than higher tariffs, and more hospital claims. Most open medical schemes appear to be affected."
Discovery Health responds to increase claims
To get an industry take on whether these claims are true, Justmoney contacted Discovery Health for their take on the current fees and medical expenses.
When asked is the medical scheme is seeing higher than normal claims by members, it said: “Discovery Health (DH) and Discovery Health Medical Scheme (DHMS) have observed an increase in hospital admission rates. Discovery Health is able to accurately predict admission rate changes based on disease burden fluctuation, and these latest increases exceed expectations. This increase in admission rate seems to be predominantly for medical admissions (non-surgical procedures), particularly in regions where there are new hospitals operating.”
This does in turn have an impact on medical inflation, however, according to the medical scheme it has “mature tools and assets to manage the admission rate and also favourable scale and financial strength to accommodate this recent change.”
Discovery Health Medical Scheme was unable to state whether or not members can expected higher fee increases this year compared to previous years. It revealed that it is still in the process of finalising its contributions and benefit changes for 2017.
Medical aid fees for 2017 will be announced in the coming weeks.
*Justmoney contacted Insight Actuaries and Christoff Raath, but had not received a response at the time of publication.
Justmoney contacted several medical schemes, but had not received responses from several at the time of publication.
