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Johannesburg - The South African medical schemes industry is stable but growth is worrying, the Council for Medical Schemes (CMS) said on Tuesday.

This followed a year-on-year increase of only 1.1 percent in the total number of medical scheme beneficiaries between 2012 and 2013, the CMS said in a statement.

It released its annual report for 2013/2014 on Tuesday, which included a report on South Africa’s medical schemes industry.

“During the 2013 financial year medical schemes continued to merge. Such developments are an expected response to market forces,” CMS registrar and acting chief executive Daniel Lehutjo said.

This was not necessarily a negative development, or an indication of instability in South African medical schemes.

On December 21, 2013, there were 87 registered medical schemes, of which 24 were open and 63 restricted.

These schemes had 8,776,279 beneficiaries, comprising 3,878,267 principal members and 4,898,012 dependants.

Over the past decade the number of medical schemes decreased from 133 to 87, with a lot of consolidation of small, restricted schemes.

“We expect moderate growth due to the medical schemes industry’s decreasing growth rate since 2010,” Lehutjo said.

“It is also the first time since 2006 that open schemes' growth, at 1.8 percent, is more than that of restricted schemes, at 0.2


Scheme contributions increased by 10.4 percent in 2013, and were R129.8 billion as of December 2013.

Contributions for 2012 amounted to R117.6bn.

The total relevant healthcare expenditure by medical schemes increased by 8.9 percent to R112.9bn from R103.7bn in 2012.

Last year was the first time since 2005 in which there was no significant increase in expenditure paid to hospitals.

Lehutjo said while the CMS was investigating the reasons for this unexpected trend, initial indications showed private hospital admissions for expensive treatments had declined.

However, payments to medical specialists increased again, with payments of R27.5bn, an increase of 8.4 percent in real terms when compared to the R25.4bn spent on this item in 2012.

General practitioners received R7.8bn or seven percent of healthcare benefits paid, an increase of 4.8 percent on the 2012 figure of R7.4bn.

The most significant increase in benefits paid in 2013 was for support and allied health professionals, such as laboratory technologists, physiotherapists and psychologists.

This amount increased by 19 percent from R7.9bn in 2012 to R9.4bn in 2013, with the category accounting for 8.4 percent of all benefits paid by schemes in 2013.

Expenditure on medicines dispensed by pharmacists and providers other than hospitals amounted to R18bn or 16 percent of total healthcare benefits paid.

This was an increase of 10.4 percent compared to the R16.3bn spent in 2012. - Sapa