Medical schemes need to revert to offering traditional healthcare cover focusing on hospitalization and a set number of annual visits to medical practitioners, says Jannie Kotze, CEO of Resolution Health.
"New generation healthcare options have become too complicated for medical scheme members to understand and invariably result in scheme members exhausting their own funds before scheme funds are accessed," he says.
Resolution Health is one of South Africa's fastest growing open medical schemes, recording its 100,00th beneficiary in August.
Promoting a "back to basics" healthcare philosophy, Kotze says the self payment gap in new generation healthcare options is advancing all the time, effectively reducing the benefits of medical scheme members.
"In new generation options, members initially tap into their medical savings accounts, which is not scheme money. Then they co-pay up to a certain level with the scheme before eventually arriving at a point where the scheme pays outright," explains Kotze.
Under older generation options, members are entitled to a certain number of visits to medical practitioners before they tap their own funds.
According to Kotze, the most common queries received by medical schemes come from members who do not fully understand the terms of their policies.
"Brokers need to advise people properly and medical scheme members must be fully aware of what they are paying for and what they are getting for their premiums," he says, stressing the need for transparency and for medical scheme options to be "as simple as possible."