DURBAN - The Council for Medical Schemes (CMS) Industry Report says that in 2020, R10.10 billion was claimed by medical scheme members for Covid-19.
The regulator for SA’s private medical scheme revealed that there were 422 894 members of medical schemes infected with Covid-19 in 2020, with 383 585 recoveries, representing a mortality rate of 3.02%.
It said the findings are based on data from 73 schemes, representing 99.84% of medical scheme beneficiaries.
The regulator also said various concessions for medical schemes were made between 2020/21. The CMS allowed for the utilisation of personal medical savings accounts to offset contributions, the relaxation of credit policies, contributions holidays and lower future contributions increases.
As a result, 19 914 members were granted contribution deferrals to the value of R586.90 million, while 16 654 members received relief through their personal medical savings accounts to the value of R180.11 million.
Dr Sipho Kabane, chief executive and registrar for the regulator, said the regulator also extended a hand to small, medium and micro-sized enterprises (SMMEs) with less than 200 employees, allowing schemes to make payment arrangements with these businesses in order to protect their employees’ cover.
Kabane said this allowed 30 725 members to receive relief through rule amendments and the impact was R133.31 million. A further 5 447 members received other types of relief such as debt policy relaxation to the value of R53.68 million.
The CMS also reported a decline in medical schemes from 78 to 76 registered schemes, as a result of two mergers, he said.
He said SA’s medical schemes covered 8.89 million beneficiaries in 2020, down from 8.99 million in 2019 – a year-on-year decrease of 1.15%.
“The average age of medical scheme beneficiaries in 2020 was 33.4 years compared to 33.04 years reported in 2019, with the average age of female beneficiaries at 34.5 years and that of males at 32.2 years.
“The pensioner ratio increased slightly to 8.9%, with increases in both males and females. The Covid-19 pandemic caused a decrease in healthcare utilisation and expenditure in 2020, due to the varying levels of lockdowns and cancellation of elective procedures and services.
“The decrease in screening activities during 2020 may also affect downstream costs as early detection normally results in lower costs and better clinical outcomes in the long-term,” said Kabane.
Overall healthcare expenditure on benefits decreased to R178.04 billion, 3.81% down from the 2019 reported amount of R185.1 billion, while hospital expenditure saw a decline of 8.38% between 2019 and 2020, from 68.4 billion to 62.7 billion.
The average amount paid per beneficiary for hospital services also decreased by 8.45% to R7 052.00, while over 92% of this expenditure went to private hospitals.
“There were also less visits to the doctor as the amount claimed by General Practitioners (GPs) decreased by 10.07% from 10.3 billion in 2019 to 9.21 billion in 2020. There was an overall decline in the amounts paid toward specialists, hospitals, general practitioners, dentists, and dental specialists, 2.26%, 8.83%, 10.07%, 7.19%, and 5.52%, respectively.
“Despite this, hospital visits by GPs saw a 15% increase in cost, with an average of R1 044.94 per event in 2019 to R1 203.43 in 2020, accounting for 14% of the total expenditure on GPs.
Out-of-hospital visits costs increased from an average of R404.62 in 2019 to R424.59 in 2020,” said Kabane.
Specialists who usually have a high claim pattern from private medical aids were also on a decline. The CMS said expenditure on medical specialists decreased by 2.2%, from R13.4 billion in 2019 to R13.1 billion in 2020.
“As expected pathology or lab specialist fees increased during the period under review amounting to R11.6 billion in 2020.
“Medicines (and consumables) dispensed by pharmacists and providers other than hospitals amounted to approximately R29.43 billion, representing an increase of 3.73% compared with R28.3 billion in 2019,” said Kabane.
THE MERCURY