Changes in the Medical Schemes Industry

Taking Stock of a Changing Medical Schemes Industry in Preparation for the Road Ahead The repeal of COVID-19 regulations midway through the year signalled the beginning of the end of what has been a turbulent time for healthcare. This has created space for renewed conversations about how best to meet the needs of healthcare consumers with new insights and a fresh perspective. Unfortunately, the economic fallout from the last two and a half years will continue to have a knock-on effect on consumers for some time, making it all the more difficult for younger, healthier individuals to purchase medical aid. This will further cement the inequalities in our healthcare system where 86% of the population depends on a heavily burdened and public healthcare system, while the remaining 14% of South Africans have access to a private healthcare system that also has its limitations. This level of fragmentation has been further frustrated by industry restrictions on medical schemes trying to provide greater access to cover for quality care. Low-cost benefit options and hybrid healthcare cover, designed to meet the most essential healthcare needs of South Africans, have become a strong theme in the mindset of healthcare consumers who, post-COVID, have pared down their spending wherever possible in response to the economic climate. Medical schemes are increasingly aware of the need to address the historical lack of member education around medical scheme products and are devising ways in which to assist financial intermediaries in facilitating an informed consumer decision-making process. At an industry level fraud, waste and abuse are of greater concern than ever in this time of scarcity. The Conduct of Financial Institutions Bill remains a topic of interest in benefiting the South African consumer, while National Health Insurance continues to dominate conversations around progress and reform. The effects of long COVID may very well change the wellness of our population and we may see more people diagnosed with cardiac conditions, diabetes mellitus, respiratory conditions, and possible kidney problems. There needs to be continuous active surveillance of our medical scheme members with regard to the development of complications and new conditions as a result of long COVID and to ensure that suitable benefits are in place to assist them where needed. There is a deep well of untapped innovation in creating solutions to meet the increasing healthcare demand in our country. Right now, the industry is at a challenging stage where socio-political issues are resulting in a misalignment between stakeholders and regulatory bodies. This protracted internal conflict is in no one’s best interest, least of all the South African healthcare consumer. Should the medical schemes industry continue to shrink, the sustainability of the private sector will erode thereby placing additional pressure on the public healthcare sector. The coming years will be some of the most crucial faced by medical schemes and a great deal of input will be required from private stakeholders across the board if we are to find constructive and practical solutions to ensure the future sustainability of the industry. If there is one thing that the past two and a half years have taught us it is that we, as an industry and as a nation, can work together when we are confronted with realities that require our most urgent attention. Some remarkable developments and collaborative efforts have come to the fore in recent years, and there is every reason why this should continue to be the case, provided that we can continue to share information, and adapt and improve on existing innovations as we work towards the common goal of better healthcare access for all South Africans.