South Africans are 'bleeding' medical aids

About 10% of the members of medical aid schemes account for half of the schemes' annual costs, according to Discovery.

Ventilation is one of the highest costs to medical aids. Other high costs include those for the treatment of heart problems, for cancer drugs, for intensive care for infants, and for Caesarian sections.

A growing concern is that the number of people that cost schemes R500,000 or more has grown.

Jonathan Broomberg, chief executive of Discovery Health, said: "In 2002, 13 of every 10,000 claimants were claiming more than R500,000. By 2012, this had increased to 28 of every 10,000 claimants, an increase of about 115%.

"There was a steep increase in the number of high-cost patients, which [adversely affects] the scheme's ability to keep contributions increases to a minimum," he said.

Six of the 70,000 people of Resolution Health's membership have claimed more than R500,000 this year, according to principal officer Mark Arnold.

Poorly understood

Because only a few members use most of the benefits, the young and healthy often feel that medical aids offer poor value for money.

"Medical aids are poorly understood. They are an insurance scheme [against incurring] huge costs," he added.

Graham Anderson, principal officer of Profmed, said more people were being treated in hospital.

A study by Econex, a research consultancy, last year showed increased use of hospitals was leading to rising medical costs.

"South Africa has a huge disease burden - the highest number of people living with HIV in the world and a growing number of people with lifestyle diseases such as heart disease, stroke and diabetes," said Anderson.

The biggest costs to medical aids are:

• Cancer drugs. Resolution Health's Mark Arnold said of the R4.5-million a month his scheme spent on medication, R1-million was for cancer medicines;
• Caesarian sections. These accounted for most of the admissions to hospital for Discovery last year;
• High blood pressure is the most common chronic disease among members of Resolution Health and Discovery;

• Hospitalisation. Medical aids spend more on hospital costs than on GPs, specialists, drugs, or dentists.

Source: The Times via I-Net Bridge