The Council for Medical Scheme (CMS) has published its annual report for 2019/2020, outlining the cost of doctor visits and other medical specialists in South Africa.
The report shows that the amount of money paid to supplementary and allied health professionals increased by 9.25% from R12.9 billion in 2018 to R14.1 billion in 2019.
Of this amount, open medical schemes spent R7.9 billion, and restricted medical schemes spent just over R6.2 billion.
The CMS found that the average expenditure per event in hospital was higher in restricted schemes at R2,851 compared with R1,478 for open schemes.
Expenditure on general practitioners (GPs) amounted to R10.3 billion, an increase of 7.55% from R9.6 billion in 2018. Hospital visits accounted for 13.4% of expenditure on GPs, with an average of R1,073 per event.
Visits out-of-hospital averaged R408. The CMS found that restricted schemes paid higher fees per event compared with open schemes.
Payments to medical specialists amounted to R13.5 billion or 7.26% of total healthcare benefits paid in 2019. Around 62% of expenditure related to treatment in-hospital at an average of R1,621 per event, and R1,243 per event out-of-hospital.
Breakdown by profession
The below graph shows benefits paid to different disciplines per event (visit) for both in and out-of-hospital.
The CMS said that total benefits paid per event is calculated as total benefits paid (from risk + savings) divided by the number of visits to a provider.
It noted that the cost (or benefits paid) per event must be interpreted with caution as the calculation does not consider other factors such as the number of hours spent per event, etc.
Events paid in-hospital from medical savings accounts of beneficiaries make up a very small part of the expenditure and relate to mainly dentist visits and dental specialist visits, it said.
The below table compares the year-on-year percentage change of average expenditure per event.
The CMS said that surgical specialist visits out-of-hospital increased by over 22% to R1,369 per event/visit in 2019 compared with R1 116 per event in 2018, while out-of-hospital pathology increased by over 19% to R4,049 per event.
Similarly, supplementary and allied health professionals visits increased by over 15% to R1,527 per event.
The average in-hospital expenditure per event for radiology increased by over 13% to R2,109 compared with R1,852 in 2018, with average events for pathology in-hospital increasing by over 10% to R4,674.