Medical Aid Funding in South Africa 2022: Medical Scheme Claims Declined in 2020 but Increased in 2021 as Members Scheduled Delayed Elective Surgeries - ResearchAndMarkets.com

2022-12-13

DUBLIN--(BUSINESS WIRE)--The "Medical Aid Funding in South Africa 2022" report has been added to ResearchAndMarkets.com's offering.

'Medical Aid Funding in South Africa 2022'

South Africa has a two-tiered, and highly unequal, healthcare system, with most of the population being state-funded. While only 14.86% of the population can afford private healthcare sector, the high costs are making it increasingly difficult for some people to continue.

Government plans to implement National Health Insurance (NHI) to fund healthcare in the public and private sectors, with most of the funding coming from general taxes and contributions of people earning above a set amount. The process, which began in August 2011, has been slow, and the NHI Bill is still under consideration in the National Assembly. The private sector has raised concerns about its affordability, and the state's ability to implement it effectively and competently.

Key Issues

Rising and unregulated healthcare costs, an ageing population and the increase in non-communicable lifestyle diseases are key challenges. Average annual consumer prices for medical services and pharmaceuticals continue to increase ahead of inflation and premiums are high, making membership unaffordable for most South Africans.

Fraud, waste, and abuse is a key issue in the industry, impacting around 22% of all claims. Fraudulent activity and abuse includes doctors and medical personnel colluding with members, submission of false claims, over-servicing or over-charging.

Trends

There has been a decrease in the number of registered medical schemes over the past two decades, mainly due to consolidation. Medical scheme membership, however, has increased. Claims declined in 2020 but increased in 2021 as members scheduled delayed elective surgeries. Changes are taking place in terms of attracting young members and low cost cover, online consultations and predictive and preventative care.

Report Coverage

This report on medical aid funding in South Africa includes information on the effects of the pandemic and recovery, membership and claims trends and the development of the NHI. There are profiles of 30 companies including the major government scheme GEMS and major private sector players such as Discovery, Momentum and Bonitas.

Key Topics Covered:

1. INTRODUCTION

2. DESCRIPTION OF THE INDUSTRY

2.1. Industry Value Chain

2.2. Geographic Position

2.3. Size of the Industry

3. LOCAL

3.1. State of the Industry

3.2. Key Trends

3.3. Key Issues

3.4. Notable Players

3.5. Corporate Actions

3.6. Regulations

3.7. Enterprise Development and Social Development

4. AFRICA

5. INTERNATIONAL

6. INFLUENCING FACTORS

6.1. COVID-19

6.2. Economic Environment

6.3. Input Costs

6.4. Fraud, Waste, and Abuse

6.5. Labour

6.6. Environmental Issues

6.7. Technology, R&D, Innovation

6.8. Government Interventions

7. COMPETITIVE ENVIRONMENT

7.1. Competition

7.2. Ownership Structure of the Industry

7.3. Barriers to Entry

8. SWOT ANALYSIS

9. OUTLOOK

10. INDUSTRY ASSOCIATIONS

COMPANY PROFILES - MAJOR OPEN MEDICAL SCHEMES

Bestmed Medical Scheme

Bonitas Medical Fund

Discovery Health Medical Scheme

Fedhealth Medical Scheme

KeyHealth Medical Scheme

Medihelp Medical Scheme

Medshield Medical Scheme

Momentum Health

Sizwe Hosmed Medical Scheme

COMPANY PROFILES - MAJOR RESTRICTED MEDICAL AIDS

Anglo Medical Scheme

Bankmed Medical Scheme

Chartered Accountants Medical Aid Fund

Government Employees Medical Scheme

LA-Health Medical Scheme

Moto Health Care

Platinum Health Medical Scheme

Profmed Medical Scheme

SAMWU National Medical Scheme

Sasolmed Medical Scheme

South African Police Service Medical Scheme

Transmed Medical Fund

COMPANY PROFILES - MAJOR MEDICAL FUND ADMINISTRATORS

3Sixty Health (Pty) Ltd

Agility Holdings (RF) (Pty) Ltd

Discovery Health (Pty) Ltd

Medscheme Holdings (Pty) Ltd

Metropolitan Health Corporate (Pty) Ltd

Momentum Health Solutions (Pty) Ltd

Momentum Thebe Ya Bophelo (Pty) Ltd

Professional Provident Society Healthcare Administrators (Pty) Ltd

Universal Healthcare Administrators (Pty) Ltd

For more information about this report visit https://www.researchandmarkets.com/r/81lv3p

About ResearchAndMarkets.com

ResearchAndMarkets.com is the world's leading source for international market research reports and market data. We provide you with the latest data on international and regional markets, key industries, the top companies, new products and the latest trends.