Medical Scheme Consolidation: Where to From Here

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ABC of Medical Schemes

With a number of schemes having answered the call from the Council for Medical Schemes (CMS) for healthcare funders to join forces where possible in order to strengthen the industry, this has been a year of consolidation for medical schemes in South Africa. Josua Joubert, Chief Executive and Principal Officer of CompCare Wellness Medical Scheme, looks at the state of play in the funding sector and at the benefits that an amalgamation can hold for members.

The South African private healthcare industry has undergone considerable change in recent years, one of the most notable being the trend towards medical scheme consolidation. This development is aligned to the White Paper on National Health Insurance (NHI) and forms part of the industry readying itself for a new healthcare dispensation.

Among the key reasons for the consolidation of medical schemes is the benefit it holds for medical scheme members. An amalgamated scheme is able to achieve a broader national footprint, greater influence and bargaining power within the market place, as well as improved cost efficiencies. These all serve to enhance the sustainability of the scheme and thereby protect members.

One proviso for such amalgamations is that schemes should complement each other well to provide a broader member-centric offering to better fulfil member needs. The recent amalgamation of Selfmed into CompCare on 1 September 2019 is a typical example of a fruitful match, placing the new scheme in an extremely strong position in a number of respects.

The combined balance sheet and increased membership size of the scheme, for example, unlocked efficiencies and economies of scale that have already brought considerable benefit for members. Furthermore, the amalgamation resulted in a new medical scheme that is one of South Africa’s top ten.

With reserves at an impressive 45%, CompCare has been placed in a position where it has been able to meaningfully give back to its members, providing them with significantly enhanced value for money, as well as a wide and highly attractive product offering to choose from for 2020.

Not only was CompCare able to add a number of exciting new benefit enhancements and great new product options, but with an average weighted increase of 6.5%, our contribution rate increases were the lowest in the industry and significantly below the industry average of 9.1% recently reported by Alexander Forbes Health for open medical schemes in South Africa.

These developments are most gratifying as they are exactly what the scheme was working towards with the amalgamation.

With its outstanding track record of more than 40 years, CompCare has a long-standing track record and is one of the most enduring medical schemes in the country. Our success over the years is attributed to the strong emphasis we have placed on meeting the needs of our members.

At CompCare, affordability, choice and security are all absolutely non-negotiable, and the scheme places an emphasis on listening to its members in order to give them exactly what they need.

CompCare partners with Universal Healthcare, an administrator that has established itself as a leader in providing evidence-based integrated healthcare services, in order to deliver services and benefits that stand head and shoulders above other medical schemes.