Most South Africans are acutely aware of the difficulties facing the state-funded healthcare service. Nevertheless, when they are ill, the majority of the nation’s citizens still have no option but to depend on its overburdened and underfunded facilities. The cost of running GP surgeries, community clinics and hospitals is increasing yearly. These increases limit the quality of care these public facilities can provide but not the steadily growing number of patients they must treat. Although such funding problems do not hamper private healthcare providers, affordable medical aid remains essential for most patients seeking treatment within the private sector.
Unfortunately, record unemployment figures combined with subsistence-level salaries continue to preclude most citizens from purchasing such cover. Sadly, it will require a substantial boost to the country’s economy before this regrettable situation can change. The problem is exacerbated by the lack of legislation to standardise the fees healthcare professionals may charge for their services. Those who work in the private sector receive fixed salaries, with modest and frequently irregular increases. By contrast, it is becoming more difficult to provide affordable medical aid. Private doctors, surgeons and other service providers are free to charge three or even five times the rates recommended by the Department of Health, as these are purely advisory. Typically, some insurers, such as KeyHealth, now undertake to cover up to 300% of the DOH recommended fees.
An Established Independent Medical Aid
A sufficiently large membership is one of the primary requirements for a scheme to ensure meeting its financial commitments. Consequently, as their costs increased, smaller companies have been forced to merge to satisfy this need over the years. Only a few, like KeyHealth, have been offering affordable medical aid for over fifty years while managing to retain our independence. An industry comprising around 200 companies in the ‘60s has since been whittled down to a mere 78. Of these, just 20 are open schemes, offering cover to anyone as a principal or dependent member.
By contrast, the remaining 58 are closed schemes, serving specifically defined groups such as miners, accountants or employees of a participating company. Typically, employees receive a substantial contribution towards the monthly premiums from their company as part of their salary package. By contrast, the self-employed must find an open scheme offering affordable medical aid.
It is easy to forget that rising prices don’t only affect consumers. Sadly, many businesses have been more than happy to use increased costs or supply shortages as an excuse to apply disproportionate price increases. However, these specialist insurers are forbidden to follow this example. Before raising their premium prices, they must justify the need for the proposed price hike to their regulatory body. The Council for Medical Schemes (CMS) will evaluate the application and approve an increase commensurate with the higher operating cost. In this way, CMS oversight helps to keep medical aid premiums as affordable as possible.
How KeyHealth Keeps Its Fees to a Minimum
Scheme managers also look for ways to keep prices down. Some elect to achieve this by trimming members’ benefits to create a cheaper product, removing or reducing the maximum sums claimable. Others attempt to make the higher premiums more acceptable by offering various unrelated incentives. By contrast, KeyHealth favours neither of these strategies. Instead, we have formed a network of preferred service providers, including clinics, specialists, pharmacies, pathology laboratories and other healthcare professionals. Network members agree to abide by a scale of tariffs based more closely on the scheme’s benefits. This innovative approach has enabled KeyHealth to maintain more affordable medical aid premiums than most other schemes.
One money-saving strategy that all schemes have adopted is the hospital plan. These products were initially aimed at young single members with good general health who were still on modest salaries and trying to save for a car or their first home. These plans offered a means to escape the crippling cost of hospitalisation following an accident or medical emergency, leaving members to pay for any minor, out-of-hospital costs they might incur. Today, however, many older and better-off individuals are also choosing these plans as they are still among the most affordable medical aid products on offer.
KeyHealth’s Affordable Medical Aid Option
Once again, KeyHealth has gone the extra mile to develop hospital plan products with better than average benefits. Main and dependent members enrolled in our Essence option will also enjoy some significant supplementary benefits, including wheelchairs, orthopaedic equipment and psychiatric treatment. They will also have free access to our Health Booster benefits. We are leaders in the design of affordable medical aid products. Download our brochure for more details about Essence.