Is a medical aid from a larger scheme always better? GTC Medical Aid Survey 2017 results reveal small medical aids also offer good value.

Findings for 2017 also highlight consumers may be unaware of their own medical aid plans and the benefits therein.

Smaller medical schemes perform well by offering consumers value for money, but they have not been as successful as some of the larger schemes in attracting new members, and thereby ensuring continued value and ‘health’ for the scheme over the long term.

This is one of the significant conclusions from leading wealth and financial advisory firm GTC in its seventh annual Medical Aid Survey for 2017, according to Jill Larkan, the firm’s Head: Healthcare Consulting.

The Medical Aid Survey analyses and rates medical aid schemes and it further provides a standardised comparison and ranking of the choices available to consumers.

“This survey cuts through the notoriously complicated landscape of the medical aid industry and simplifies it according to the factors that matter most when consumers choose a medical aid scheme and option,” explains Larkan.

This year’s survey reviewed 23 open medical aid providers (Profmed is the only Closed scheme reviewed this year), with a total of 144 plans, which were categorised into 11 areas according to benefits offered. The categories range from entry-level to traditional plans, and include hospital-only, saver and comprehensive options. GTC has excluded all Top-up Plans as well as all Primary Care plans from this year’s survey, with a view to producing an entirely separate survey for those categories going forward.

The Medical Aid Survey from GTC assigns every plan with a micro – indicating a plan’s competitiveness in relation to others in the same category – and macro rating – broadly a measure of a scheme’s ‘health’, and considers factors such as membership size and growth, average age and financial stability.

“We have simplified this year’s assessment which has allowed us to compare plans more objectively, by confining this year’s review only to open medical aid schemes and excluding all short-term top-up/gap and healthcare policies,” says Larkan.

Smaller medical schemes score well yet again in GTC’s micro ratings

Smaller medical schemes have again scored well in the micro ratings.

“Fedhealth is one of the schemes that has performed consistently well in the micro ratings, indicating that it is very competitively priced and can offer consumers good value for money,” she says.

With this year’s inclusion of multiple additional macro demographic areas in the GTC survey, along with the applied weightings on these, the more stable growing schemes have now scored considerably better in the macro rating. Discovery Health has topped these macro rankings in the 2017 survey.

“This year we have included a broader range of areas in determining the macro rating, and have weighted each according to the importance thereof in the decision-making process for consumers,” says Larkan. “In previous years we assigned equal weights to each factor, whereas this year’s survey shows a variation in the weightings of areas such as membership, average age or solvency, according to the relative degree of impact that these elements have on the overall decisions by consumers.”

Larkan believes that if smaller schemes are unable to attract more (and younger) new members, they will not be able to continue as good-value options for consumers, and ultimately become less sustainable as their demographics begin to deteriorate over time.

Consumers unaware of their own medical scheme details and entitled benefits

“We have found that many consumers tend to be largely ignorant about which medical scheme option they are on and what benefits this entitles them to.”

She points out that consumers can potentially save significantly when they do an honest and thorough analysis of their real medical needs. Monthly payments which consumers make for their medical aid plan include a monthly fee for consumers to obtain professional guidance and advice, something which many people are unaware of.  Larkan emphasises that the assistance of a professional healthcare consultant should never be discounted or replaced.

“One example of saving is to use a medical aid’s network option. People living in an area where there is a comprehensive network of preferred medical practitioners and hospitals can downgrade and get the same benefits for a lower price.”

Individual medical aid needs change each year – make sure your cover is right for you, today!

 Another further benefit of an in depth analysis carried out by your Professional Healthcare Consultant would be knowing whether the scheme and plan is still appropriate to your current needs, she says.

“Too many consumers stay on the same plan for years, regardless of how their circumstances or plan’s benefits change. This means consumers tend to pay for benefits they don’t need, or they are unaware of benefits that are no longer provided,” Larkan explains.

“We have also seen medical aids become more standardised in some areas, such as preventative wellness programmes, and maternity benefits. These salient features are now so commonplace that they can no longer be used as differentiating factors when selecting a medical aid. Other benefits, though, have become more complicated and difficult to compare for consumers, such as dentistry or day ward cover, with their myriad of co-payments and deductibles.”

“It is always a useful exercise to compare last year’s usage, with anticipated usage for next year to gauge whether you are getting the best value for money, or whether you should consider alternate plans.”

Choosing the right plan is complex and different for each individual

According to Larkan the choice of medical aid and plan is complex and differs for each individual, but consumers can start their process by considering three basic factors.

• In-hospital cover level: “This depends largely on the level of risk you wish to carry should you be hospitalised in the coming 12 months. If consumers have a top-up health plan, then this factor is less important, as these generally extend the level of in-hospital cover.”
• Network options: “This depends on whether you accept a discounted premium rate in exchange for having access to a limited network of hospitals / service providers.”
• Out-of-hospital charges: “This refers to the level of risk you are willing to take on, or discipline you have in paying for non-hospital expenses.”

She continues: “One area of the market we believe is not getting sufficient attention is that of low-income options. The Demarcation Regulations that were published at the end of 2016 – which stipulate that short-term healthcare insurance products must be registered as medical aids in the next two years – should bring significant change to the market in this respect. This area of the market is becoming increasingly aware of the exorbitant cost of healthcare to provide acceptable levels of care within a medical aid. Without urgent adjustments to the proposed amendments to the minimum basket of benefits to be provided by all medical aids, these members are unable to afford medical aids, and will remain uncovered which will maintain the burden on the state, and in many unfortunate cases, they will remain without any medical care whatsoever.”

GTC’s overall list of schemes for 2017 – ranked by ‘likelihood of support’

 The full range of plans in this year’s Medical Aid Survey – from entry-level to comprehensive have been divided between network and non-network plans and been graded (micro, macro and combined) to simplify the choice and provide an easy way to compare options and cost.

“This, rightly, makes up the bulk of the report as this is what the majority of members, companies and healthcare consultants are most concerned with. The schedules provide detailed scoring and cost analysis, which is then simplified by our ‘likelihood of support’ rating of high, medium, or low,” says Larkan.  “This rating indicates the likelihood of us recommending a particular plan given the schemes’ demographics, cost and rating which we have developed.”

Larkan believes that the overlay of the macro rankings on the micro premium extrapolations form a solid guide towards decision making, while simultaneously easing the member, company or consultants’ ongoing investigatory burden.

The macro and micro rankings combine to create GTC’s overall list of schemes in the Medical Aid Survey for 2017 ranked by “likelihood of support”.  This final analysis reflects a score which indicates the likelihood that a particular plan / scheme would receive GTC’s support or not through recommendations to clients.

	NETWORK	NON-NETWORK
Entry Level Comprehensive  Student
Entry Level Hospital Only	Discovery Keycare Core
Comprehensive Low State (R3000 – R7000)	Makoti Primary
Comprehensive Low (R3 000 – R7 000)	Makoti Primary	Sizwe Gomomo Care
Comprehensive Mid (R7 000- R10 000) Student Market	Makoti Primary	Sizwe Gomomo Care
Hospital Only	Momentum Custom	Genesis Private Choice
Saver	Discovery Essential Delta Saver	Topmed Active Saver
Saver Plus	Resolution Millennium	Discovery Essential Priority
Comprehensive Risk	Momentum Extender	Discovery Essential Comprehensive
Comprehensive Complete	Discovery Classic Delta Comprehensive	Discovery Executive

*table above only highlights the rankings for a family of four (Principal Member + Adult + 2 Children)

 

As Larkan says, “This list reflects the overall best scoring plans in our comparisons across all sectors.

This is by no means a definitive or final rating, as ‘soft’ factors such as existing servicing relationships, past experience, administration ability, SLA’s and turnaround times and / or call centre availability have not been taken into account,” cautions Larkan.

“No medical plan is going to suit all members equally, but our annual survey helps to ensure that an informed decision can be made based on these indicators, which will go a long way to easing member concerns regarding scheme performance relative to peers and their plan’s ‘health’ status,” Larkan concludes.