The rising costs in South Africa’s private healthcare sector are affecting medical aid members due to a shortage of specialists, dubious billing practices, and lack of price regulation. Over five years, treatment costs for conditions like cancer and musculoskeletal issues have significantly increased, leading to higher out-of-pocket expenses. Sirago Underwriting Managers emphasizes that gap insurance is essential for covering differences in specialist fees and medical scheme reimbursements.
The private healthcare sector in South Africa is experiencing significant increases in costs related to treating members of medical aid schemes. Contributing factors include a shortage of medical specialists, questionable billing practices by some providers, and an absence of price regulation for healthcare specialists. These challenges are placing a financial strain on medical aid members, as their out-of-pocket expenses continue to grow.
A notable shift over the past five years has been the escalation in treatment costs for common conditions that lead to gap claims, including cancer, circulatory, and musculoskeletal issues. According to Martin Rimmer, CEO of Sirago Underwriting Managers, the consistency of these treatment types remains, however, the associated costs have significantly risen, leading to greater shortfalls not covered by medical schemes.
Sirago illustrated the issue with data from their 20 largest gap cover claims for 2024. They explained that gap insurance addresses the disparity between the fees charged by healthcare specialists for in-hospital procedures and the reimbursement provided by medical schemes. This is applicable regardless of whether the healthcare provider has entered into tariff agreements with the scheme.
In summary, South Africa’s private healthcare sector is grappling with rising treatment costs for medical aid members, largely fueled by a lack of medical professionals, questionable billing practices, and inadequate pricing regulations. Understanding these dynamics is crucial for members, as the financial implications are becoming increasingly burdensome. The insights provided by Sirago highlight the scope of the issue, especially concerning common medical conditions and the resulting shortfalls in coverage.
Original Source: citywire.com
