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‘Medical cover on wane’ by KATHARINE CHILD | 04 September, 2013 00:56 TIMES LIVE

Medical aid members could have to pay more from their own pockets for medical expenses, as private hospital costs and specialists use up more and more of medical aid premiums each year.

"Something has to be done," said health economist Professor Alex van der Heever, speaking on the Council for Medical Schemes’ annual report, which was released yesterday.

According to the report, R117-billion was paid in premiums to medical aids last year.

Of that, R103-billion was paid out to cover members.

But each year, an increasing amount of medical aid premiums go towards private hospitals and specialists, said the council’s registrar Monwabisi Gantsho.

Gantsho said: "The prices that specialists and private hospitals charge should be regulated."

He noted that:

  • In 2012, 36.7% of premiums went to hospitals, an annual increase of 8.5% after inflation;
  • 23.3% went to specialists, an annual increase of 10.3% after inflation;
  • 15.8% went to medicines;
  • The amount of medical aid premiums spent on hospitals increased by 88.2% between 2000 and 2012;
  • The amount spent on specialists increased by 82.9% between 2000 and 2012;
  • The amount spent on GPs increased by 35.6% over the past 12 years, and
  • The amount spent on dentists has decreased by 17.7% since 2000.

Gantsho said the increased costs of hospitals and specialists were curious because medical aid members in 2012 "were not any older and therefore not likely to be sicker than in 2000".

Van der Heever said: "There is no rational basis for the increase in costs. You can’t have such a dramatic annual increase of 8% spent on hospitals, even as hospitals get new technology."

The consequence, said Van der Heever, is that schemes will provide increasingly less cover for medical aid members, who will have to dig into their own pockets to pay the excess.

Bonitas Medical Fund executive principal officer Dr Bobby Ramasia agreed that hospital costs accounted for 44% of its total claims costs.

The Competition Commission will launch an inquiry into private health care costs later this month.

Ramasia said new medicines and improved technology were part of the reason that medical aids spent more money on hospitals.

The head of the Private Practitioners’ Forum, Dr Chris Archer, said the increased cost of specialists and hospitals were only just above inflation each year and slammed the call for regulation .

"It is a global trend that hospital and medical costs increase by 2%-3% above inflation each year."

He added that increased spending on private hospitals and specialists was linked to their being utilised more often.

TRUSTEE COSTS

THE highest-paid trustees of medical aid schemes that are not-for-profit trusts:

  • Government Employee Medical Scheme: R545000;
  • Spectramed: R441000;
  • Discovery Health Medical Scheme: R402000;
  • Liberty Medical Scheme: R334000;
  • Fedhealth Medical Scheme: R323000.

The Council for Medical Schemes is trying to determine what would be equitable remuneration for trustees.

Medical schemes say trustees are responsible for managing billions of rands and should be paid accordingly.

COMPLAINTS

OPEN schemes most complained about:

  • Resolution Health;
  • Spectramed;
  • Genesis;
  • Medshield.
  • Restricted (employees only) schemes most complained about:
  • PG Bison Medical Aid;
  • SA Breweries Medical Aid;
  • Netcare Medical Scheme;
  • PG Group Medical Scheme.

There is a correlation between schemes against which the most complaints are made and schemes that do not have adequate internal dispute resolution procedures, necessitating recourse to the Council for Medical Schemes .