Insurance / 23 November 2019, 3:00pm / Staff Reporter
Medical schemes are facing pressure in a low-growth market where customer expectations and utilisation are high and increasing, while loyalty is on the decline as a result of lower price tolerance. As the economy bites and more consumers opt to downgrade their cover in a bid to cut costs, they are not readjusting their expectations and are struggling to understand complex benefit options and scheme rules.
These are some of the findings in the latest SA Customer Satisfaction Index (SA-CSI) for Medical Schemes (2019) conducted by Consulta, which provides insights into the overall level of satisfaction of customers of five of South Africa’s largest schemes: Bonitas, Discovery, the Government Employees’ Medical Scheme (Gems), Medihelp and Momentum.
Consulta polled 1707 medical scheme members in the five schemes, with Gems the only closed medical scheme in the survey.
Across the schemes, respondents indicated that they did not believe the quality of cover and their experience matched the premiums paid.
Bonitas (75.1 points) and Discovery (74.8) came out tops in the survey. Medihelp (73.5) was slightly above the industry average (72.9), Momentum scored just below average (70.7) and Gems had the lowest score at 68.3. Overall customer satisfaction increased 1.3points, from 71.6 last year.
Bonitas and Discovery were the only two schemes to show an improvement on their 2018 scores. Bonitas showed a big improvement of 4.9points, while Discovery improved by 1.7points.
Gems (-0.5), Medihelp (-1.6) and Momentum (-1.3) showed a decline on overall customer satisfaction compared with their 2018 scores.
One of the components, perceived value, is a measure of the quality relative to the price paid. On the value index, Medihelp (71.6) had the highest score, followed by Bonitas (70.9), Discovery (70.6), Momentum (71.4), and Gems (66.1). The average was 69.6.
Regarding complaint incidence across the industry, customers complained most about fees and charges (22%), claims issues (19%), terms of cover or scheme rules (13%), feedback (9%) and waiting time (7%). Discovery and Medihelp had the most complaints about fees and charges, both at 28%, above the industry average (22%). Medihelp had the highest incidence of claims-related complaints at 26%, well above the average of 19%.
SA-CSI founder and chairperson Professor Adré Schreuder said the strongest predictors of satisfaction in the medical schemes sector is the degree to which customers feel that their health-care cover provides peace of mind and their provider delivers as they were led to believe.
“It is notable that customers complain most often about the detail and performance of their cover, the related fees and costs, additional out-of-pocket co-payments, and for claims not being covered in particular when it comes to chronic medication,” Schreuder said.
“The reality of the private health-care system is that it is a minefield for consumers to understand, fraught with industry jargon, complex benefit designs and scheme rules, which make direct comparisons onerous, if not impossible at best.
"And it is this complexity that leads to customer dissatisfaction, as members simply do not fully understand the scope of their cover and what they are liable for in event of a claim.
"Satisfaction levels for medical schemes are substantially lower than those measured in other financial services industries.”