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The cost of being sick in South Africa

By Isabelle Coetzee

Finding affordable healthcare in South Africa is possible, but it comes with its own challenges. Patients often wait for hours to be assisted, and fatigued doctors sometimes miss underlying conditions.

“Private healthcare is generally regarded as being good, while the public healthcare is regarded as being in decline even though the majority of citizens rely on this service,” says Vaughn Harrison, a partner at Hogan Lovells with 25 years’ legal experience in the healthcare industry.

He adds that this is despite the high percentage of funding that’s being allocated towards public healthcare. If South Africans decided to skip the queues at local clinics, how much would they have to pay for a visit to a general practitioner?

Justmoney contacted 13 doctors in Cape Town to help answer this question. We also found out how medical schemes assist with these costs, and we compared South Africa with its BRICS counterparts.

On average, South Africans can expect to pay R439 for a doctor’s visit. Have a look at the below table to see how much you’d have to pay for a single appointment:

 

Area

Price per consultation

Foreshore

R600

CBD

R430

CBD

R450

De Waterkant

R500

Vredehoek

R550

Parow

R430

Goodwood

R350

Bishop Lavis

R300

Mitchells Plain

R300

Milnerton

R500

Kraaifontein

R450

Durbanville

R500

Guguletu

R350

Average

R439

 

Note that a single doctor was contacted in each area and that these numbers do not reflect the ultimate cost of visiting a doctor in these suburbs. However, based on the above table, doctors closer to the centre of Cape Town charged more for consultations.

How can medical schemes assist with these costs?

According to the Council of Medical Schemes (CMS), South Africans could choose from 80 medical schemes in 2017, each of which offered between 2.4 and 6.5 benefit options. At the time, approximately 4 million South Africans were members of these schemes, with just under 8.9 million beneficiaries.  

Harrison explains that medical aid contributions per average beneficiary was R1,727.10 per month during the same year. In return, beneficiaries’ medical schemes paid for their medical expenses, based on their provider and their unique benefit options.

But what value do South Africans get for this service?

Consulta recently released its South African Customer Satisfaction Index (SA-csi) for 2018, which looked at whether South Africans were satisfied with their medical schemes.

It found that the industry average had declined since the previous year, from 74.2 to 72.7. This is because customers were less satisfied with two of the largest medical schemes, Discovery Health and Bonitas.

Pull-out quote by PJ Claasen: "When claims are not paid, co-payments are high, treatment cannot be given, and savings run out early, it results in low perceptions of value for money

PJ Claasen, head of Customer Experience and People Solutions at Consulta Research, explains why customers don’t believe they are receiving value for their money.

“Customers pay a lot for their medical cover, resulting in expectations being very high. When claims are not paid, co-payments are high, treatment cannot be given, and savings run out early in the year, it results in low perceptions of value for money,” says Claasen.

“When customers have to go through a lot of effort to deal with a provider, through slow communication, poor online channels, or complicated systems, this may also have a detrimental impact on value,” he adds.

The research shows that South Africans are frustrated by higher premiums with fewer benefits, and they’re finding less value for money when it comes to medical schemes. This may result in citizens paying out-of-pocket or opting for free clinics instead.

South African healthcare compared to BRICS

The next big question is: “Is this normal?” It’s important to understand whether South Africa is in line with its peers or not.

BRICS countries (including Brazil, Russia, India, China, and South Africa) are considered the five major emerging economies in the world. Due to their shared economic status, they’re often used as benchmarks to compare one another with.

Harrison had a look at how South Africa’s healthcare system compares to other BRICS countries. Among other sources, he looked at data from the National Department of Health (NDoH) and the World Health Organisation (WHO), and compiled the below table:

 

Country

Voluntary health insurance that funded health expenditure as a % of total health expenditure (WHO in 2016)

Total health expenditure as a % of GDP (WHO in 2015)

Government health expenditure as a % of GDP (WHO in 2015)

Total health expenditure per capita at purchasing power parity (in USD) (WHO in 2015)

Brazil

22%

8.91

3.81

$1,391.52

Russia

2%

5.56

3.40

$1,414.03

India

4%

3.89

1.00

$237.72

China

4%

5.32

3.18

$762.24

South Africa

36%

8.20

4.39

$1,086.41

 

In 2016, medical aid contributions funded 36% of health expenditure in South Africa. This is incredibly high compared to other BRICS countries, with Brazil taking second place with only 22%.

In 2015, South Africa spent 8.2% of GDP on healthcare, of which 4.39% was funded by government. This is the second largest gap between the two figures, with Brazil spending slightly more on healthcare, of which slightly less was funded publicly.

Each South African spent an average of $1,086.41 (R15,001.86) on medical expenses in 2015. Among the BRICS countries, South Africa stands in the middle, with both Brazil and Russia having spent more per capita during the same year.

So, what does this mean? South Africa is not outperforming its economic counterparts in terms of healthcare, but it’s also not straying too far outside of their parameters. At its worst, more citizens are spending money on medical schemes than in other BRICS countries.

What does the future hold?

The National Health Insurance (NHI), of course.

“The government has announced its intention to provide health care to all. This will be a big task, and one needing careful management, as it will be a costly project. Also no estimates regarding the costs of introducing the NHI have been furnished to date,” says Harrison.

“The NDoH must tread carefully when introducing the NHI, so as not to disrupt the private healthcare sector and the various professionals engaged therein, such as doctors, dentists, and nurses,” he adds.

Pull-out quote by Vaughn Harrison: "The costs of extending medical care to all, and attempts to make this affordable, will continue to tax South Africans."Once implemented, this will allow decent medical cover for all South Africans. It will diminish the long queues and spread the healthcare burden across all sectors, ensuring all citizens have access to the assistance they need.

To improve the country’s health, South African taxpayers can expect their funds to be allocated towards the NHI.

“While it is frequently stated that the only certainties in life are death and taxes, it can also be said that the costs of extending medical care to all and attempts to make this affordable, will continue to tax South Africans,” says Harrison.

He explains that issues of medical costs and coverage is a vexed one for all societies. Even in larger economies, like America, affordable care as it is known, is not universal, and it also wrestles with high medical costs.

This article has been prepared for information purposes only and it does not constitute legal, financial, or medical advice. The publication, journalist, and companies or individuals providing commentary cannot be held liable in any way. Readers are advised to seek legal, financial, or medical advice where appropriate.

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