Despite the ongoing tendency for private healthcare costs to escalate year on year, some medical aid schemes still have affordable products for 2023. Private healthcare was expensive even before the Russian invasion of Ukraine and the resulting supply chain disruptions, widespread shortages and inflated prices. On average, before your surgeon picks up a scalpel, you could face a fee of up to R7 000 for the services of an anaesthetist when undergoing a two-hour operation. Lengthier procedures will add a further charge of just over R700 for each additional 15 minutes.
A straightforward appendectomy could set you back over R27K before you add the cost of accommodation and medication. A bill like that could put a sizeable dent in the monthly salary or savings of someone without medical aid. Keeping premium prices affordable poses an ongoing challenge for companies providing financial help to meet private healthcare costs. When premium hikes are unavoidable, they are always well justified.
Modern Healthcare Relies Heavily on Technology, Adding to Medical Aid Premiums
Advances in medical technology have also contributed to higher costs in both the public and private healthcare sectors. Medical imaging techniques like computer-assisted tomography (CAT) and magnetic resonance imaging (MRI) have become invaluable tools, essential for the early and accurate diagnosis of life-threatening conditions, such as malignancies. Cardiac catheterisation equipment enables the cardiologist to identify arterial constrictions and treat them, delaying the need for the far riskier option of performing open-heart surgery. However, all these machines come with a high price ticket, and the expenses don’t end with the purchase.
Operating them requires specially trained staff, and the equipment must undergo regular inspection and maintenance. The imaging equipment, in particular, consumes vast quantities of electricity whilst in use, which, like all essential commodities, is subject to regular price hikes. Consumable items such as X-ray film and recording media also add to the operating costs, which, in the long term, can add to the cost of your monthly medical aid premiums.
Medical Aid Schemes Operate Under Strict Regulation
While the services supplied by these schemes closely parallel those of the nation’s insurance companies, they are required to operate on a very different basis. In compliance with section 21 of the Companies Act of 1961, they are required to trade on a not-for-profit basis. Rather than a board of directors and shareholders, they are answerable to a panel of trustees. In 1998, the South African Government introduced the Medical Schemes Act. Among other things, the Act made provision for the formation of an independent regulatory body known as The Council for Medical Schemes (CMS). As well as mediating conflicts between schemes and their members, the Council also applies certain constraints deemed necessary to protect scheme members. For example, while modest premium increases tend to be an annual event, these must be limited to the amounts agreed upon by the regulatory body.
Other Constraints Applicable to South Africa’s Medical Aid Schemes
Although they depend on the same statistical principle of shared risk as insurance companies, scheme managers have less freedom to decide for whom they provide cover and how much they can charge for their services. For example, a short-term insurer is entitled to refuse to cover drivers who have a record of multiple claims or penalise them by loading their premiums. By contrast, scheme managers must provide cover for all applicants, irrespective of any pre-existing medical conditions. Furthermore, they must apply the same monthly premium payments for all those who purchase a given product.
To extend the services to members, the Act also mandates all schemes to include certain prescribed minimum benefits (PMBs) in each of their products. For example, even their cheapest option must cover the cost of diagnosis, treatment and care of 26 named chronic illnesses, including asthma, diabetes, epilepsy, hypertension and multiple sclerosis, while attempting to keep premiums affordable. One solution is the hospital plan.
A Hospital Plan is the Most Affordable Medical Aid Option
A hospital plan could be the answer if your disposable income is sufficient to pay for the occasional GP visit and the cost of prescribed and over-the-counter medicines. It will cover all the bigger expenses arising from accidents and medical emergencies while including the mandatory PMBs. KeyHealth offers you the choice of six products in our 2023 portfolio to cater for most budgets. These range from entry-level and extended hospital plans to fully comprehensive cover. Furthermore, each includes three unique and valuable additional core benefits free of charge. We invite you to click here to view their benefits and monthly premiums.