Smaller schemes rank high in medical aid value survey

Two smaller medical schemes – CompCare and Fedhealth – trumped their larger rivals in the first independent, publicly released comparison of medical aid plans by GTC Healthcare.

Scheme options were divided into 10 categories as GTC (formerly Grant Thornton Capital) took a microscope to the country’s 22 open medical schemes. Jill Larkan, the Head of GTC Healthcare, says that although this is the fifth annual survey of medical aids, it is the first time the results have been made public. 

The survey looked closely at in-hospital benefits, as these represent 60 percent of all costs carried by medical aids. In-hospital cover levels vary from 100 percent to 300 percent. Larkan says, in general, plans were divided into lower-cost ‘saver’ ranges, and higher-end ‘comprehensive’ options. She says the price depends on whether a scheme member agrees to use an existing hospital and doctor network. “More people now choose the saver range than ever before – mainly due to recent steep rises in medical aid prices. People who were on comprehensive plans are moving down because of costs,” said Larkan. 

Profmed ranked top in the saver range with no network, while CompCare tops the saver range with a network option. Larkan said the results show the lowest cost, rather than which medical aid provides the best benefits. Members still need to compare benefits line for line, and to decide whether these meet their main needs. On the comprehensive options Fedhealth came out tops with its Maxima Standard net and Maxima Basis options. 

Jeremy Yatt, Principal Officer of Fedhealth, says one of the biggest challenges facing medical schemes is that of affordability – keeping the monthly contributions members pay affordable while still ensuring members have access to good quality healthcare. In the Fedhealth environment sophisticated predictive modelling techniques show that 2,5% of the Fedhealth population are likely to drive 30% of medical scheme costs going forward. Virtually all of these members have multiple chronic diseases. “Of concern is that over 60% of these individuals receive fragmented care and we believe this profile is likely mirrored across many other schemes. Those beneficiaries whose care is fragmented cost nearly double compared to those who are well coordinated,” says Yatt.  

The medical schemes industry needs to start implementing measures to coordinate care in order to improve clinical outcomes and reduce contributions. GP and Specialist networks are the first step to impact on member outcomes and contributions by improving care coordination. Most successful healthcare systems have identified care coordination as key to the sustainability of healthcare funding. 

“It is all about achieving the best health outcome and we would like members to be more circumspect in what they are paying for and who they see. We are thrilled to have been ranked so highly in the survey outcomes and will continue to drive down costs without compromising on our benefits for members,” concludes Yatt.