“For example, the impact of prescribed minimum benefits at cost is beginning to show considerable negativity on healthcare affordability. Unfortunately, supply side manipulation adds pressure to an already volatile costing infrastructure,” says Neil Nair, principal officer of SAMWUMED medical scheme.
The recipients of these unfavourable conditions are unfortunately the members of medical schemes and South Africans in general, who end up bearing the brunt of increased costs, points out Nair. “The scary reality is that most members of medical schemes have started to face double-digit increases in their premiums, adding increased pressure to already over-stretched household budgets. The real cost drivers remain the cost of healthcare delivery.”
This sentiment has been echoed by the minister for health, Aaron Motsoaledi, who earlier this year had also pointed out that, over the past 10 years, private healthcare costs in the country had risen by 300%. These concerns resulted in the Competition Commission of SA conducting a market inquiry into the private healthcare sector, which is currently underway and has a strong focus on healthcare costs.
“We are confident that the impetus by the department of health and the new leadership at the Council for Medical Schemes (CMS) will usher in a more responsible cost philosophy for private healthcare,” adds Nair.
With a strong focus on providing affordable healthcare for its members in 2017, the self-administered local government medical scheme, SAMWUMED, has announced an average weighted benefit increase of 9% in 2017 for both its benefit options.
According to, the scheme was able to keep its premium increases on both its benefit options in the single digits through a prudent costing cushion of very low non-healthcare costs, a cautious approach to tariff negotiations and a fair reserve ratio.
Nair explains that having faced a challenging year thus far, similar to most South African medical schemes, SAMWUMED was forced to undertake a comprehensive review of its value offering to members and indeed new entrants to the market in 2017. “Given the already unaffordable cost of medical aid, which prohibits lower income entrants into the market, we have endeavoured to stay true to our founding philosophy of quality healthcare at affordable rates.”
He says that the SAMWUMED’s strong solvency ratio has also helped to ensure that increases are kept as lowest as possible.
In addition providing a low premium increase in 2017, the scheme has also focused on improving a number of benefits for our members. Nair says that this includes; a 40% increase on in- and out-of-hospital radiology and pathology benefits, child immunisations and screenings now being covered at private pharmacies, provision of wound care through primary care facilities, as well as improvements on both our preventative care and maternity benefit programme – amongst others.
