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(Getty)
- In the past five years, the amount that members of the South African health plan pay for health care out of their own pocket has increased by 55%.
- In total, healthcare members spent R35 billion in medical and cash savings to cover their bills.
- Most of your own expense goes to drugs that are not directly covered by your plans.
- For more stories, visit www.BusinessInsider.co.za.
South African members of health plans spent at least 17 billion rand, counted conservatively, from their own pockets last year to cover their medical expenses, an increase of 55% in the past five years.
They withdrew another R18 billion from medical savings, totaling R35 billion not paid directly for their medical aids, data released by the Council for Medical Schemes (CMS) this week shows.
CMS calculates out-of-pocket costs as the difference between claims submitted by health plan members and the amounts paid for those claims. You think it is an indication that can be used to track trends, but not a number that can be trusted as such.
“This is an understatement of the true [out of pocket expenses] incurred by members, as medical schemes are likely not to fully capture and account for all costs associated with seeking medical care, “says CMS of its approach.
A large majority of recorded out-of-pocket expenses went to dispensed drugs, with 33% of the total amount, a proportion that remained stable between 2018 and 2019. The next closest category was complementary and related health professionals, with 14% of the total. All other areas were below 10% of the total out-of-pocket amount, including GPs (9%), specialists (8%), hospitals (7%), and dentists (6%).
The breakdown of out-of-pocket expenses recorded by medical plans. (CMS Annual Report)
But when viewed as a fraction of the total payments on different types of medical expenses, hospitals loom larger. Of the total spending within the categories, members of healthcare paid just under 14% of the drugs dispensed out of their own pockets. Surgery specialists were the next most expensive, with 6.3% of total costs borne directly by members, closely followed by total hospital spending at 6.2%.
When it comes to GPs, out-of-pocket payments, or at least those posted to medical plan bills, accounted for just 2.3% of total spending for the year, and dental specialists were even lower , with 1.2%.
How medical savings are spent
Healthcare members used approximately R18 billion in medical savings in the year.
As with out-of-pocket payments, the money from the medical savings accounts went mainly to medicines, which represented 37.4% of the total amount. Another 19.5% went to specialists, 18% to complementary and related health professionals, and 14% to general practitioners, while payments to dentists accounted for 8%.
Such health savings could be under pressure, health plan bills show; per member, once corrected for inflation, South Africans were saving 1.76% less on these types of vehicles than the previous year.
(Compiled by Phillip de Wet)
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