Best and worst medical aids in South Africa

Not a single medical aid is meeting the expectations of policy holders. This is according to the latest South African Customer Satisfaction Index (SAcsi) survey.

Healthcare policies a grudge purchase

A sample of 3,297 medical aid policyholders took part in the study through telephonic and web-survey methods in late 2014.

Customers gave the health insurance industry a satisfaction score of 74.1 out of 100 with Bonitas coming out as the best medical aid, scoring 1.8 points above the industry average.

The companies included in the medical aids survey were Bonitas, Discovery Health, Liberty Health, Medihelp and Momentum Health based on their market share. There was a minimum of 298 respondents per company.

Ranking on par was Discovery Health (74.1), GEMS (74.3), a category of “Other” (74.9) and Medihelp (73.4), while Liberty Health and Momentum Health lag behind the industry average at 71.1 and 69.6 respectively.

“The results show that not a single scheme is meeting the expectations of its customers”, said Prof. Adré Schreuder who is the founder of SAcsi and CEO of Consulta Research.

“Medical aids should remember that healthcare policies are a grudge purchase and therefore take a closer look at improving perceived value,” he said.

Medical aid SAcsi Score Difference from average
Bonitas 75.9 +1.8
Other 74.9 +0.8
GEMS 74.3 +0.2
Industry Average 74.1
Discovery 74.1 0.0
Medihelp 73.4 -0.7
Liberty Health 71.1 -3.0
Momentum Health 69.6 -4.5

Potential gap in the market

Medihelp and Discovery Health have improved their overall customer satisfaction scores since the last SAcsi measure by 2.4 and 2.1 points respectively, whereas the scores of Momentum Health and Liberty Health dropped by 2.4 and 1.9 points respectively.

“The low value-for-money perceptions for these two brands likely influenced their position in the SAcsi,” said Schreuder.

SAcsi looked at satisfaction with the three types of medical plans: comprehensive, network schemes and hospital plans.

It found that the network option is not perceived as good value relative to comprehensive or hospital plans. Overall satisfaction with network plans is also lower.

“It may be that customers with network plans do not completely understand the co-payment aspect of many network schemes, which could be contributing to the lower scores,” noted Schreuder.

He pointed out that there is a potential gap in this market related to the degree to which a product can be customised to meet an individual’s unique needs.

Failure to pay for PMBs

Meanwhile, Section 27 has called on medical aid holders to share their experience with the Competition Commission’s Market Inquiry into South Africa’s Private Health Care Sector.

The inquiry is mandated with looking into the general state of competition in the sector, to figure out how we can achieve accessible, affordable, quality private health care in the country.

It is crucial for the inquiry to hear from medical scheme members and patients, said Section 27’s lawyers, Tim Fish Hodgson and Sher-Muhammad Khan at a workshop held in May in Braamfontein offices.

A failure to pay for Prescribed Minimum Benefits (PMBs) is one of the top complaints laid with the Council for Medical Schemes, which is tasked with protecting the interests of the public.

It has ruled that literal interpretations of PMB regulations are not acceptable, but medical schemes continue to attempt to escape paying PMB claims by all and any means, the lawyers say.

To make a contribution you could approach the Commission directly at ccsa@compcom.co.za or via Section 27 at healthinquiry@section27.org.za.

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