The best and worst medical aids, according to South Africans

Consulta has published its latest South African Customer Satisfaction Index (SAcsi) for the local medical aid industry, outlining the medical aid schemes with the happiest customers.

The data shows that the overall customer satisfaction of members of South Africa’s most prominent medical schemes has sharply declined in 2021, and some have recorded their lowest customer loyalty scores in six years.

The data is based on a poll of 1,950 medical scheme members during the first half of 2021, with the country’s six largest medical schemes the main focus of the survey.

In the 2021 index, Bestmed emerges as the leader on overall customer satisfaction, with all other schemes performing on or below industry par.

Based on the customer satisfaction ratings, Bestmed attained a score of 76.7, above the industry par score of 73.5.

Bonitas (73.7), Discovery (73.7) and Medihelp (72.3) all come in on around the industry par (73.5), while GEMS (69.4) and Momentum (69.9) are below par.

The least satisfied customers remain those with low to minimal benefit utilisation and who face co-payments and out-of-pocket expenses on day-to-day primary healthcare needs and chronic medication.

Members on network plans (71.0) and hospital plans (72.5) are less satisfied than those on comprehensive plans (75.5).

Medical aid Score
Bestmed 76.7
Bonitas 73.7
Discovery 73.7
Industry par 73.5
Medihelp 72.3
Momentum 69.9
GEMS 69.4

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“As medical schemes enter renewal season in October when they announce benefit changes and premium increases for 2022, the findings of the latest index are significant,” said Ineke Prinsloo, head of customer insights at Consulta.

“With customer satisfaction levels and loyalty scores at one of their lowest points in years, and with consumer price tolerance at equally low levels, there’s likely to be significant shifts of members to lower cost-benefit plans and between medical schemes as customers try to balance value, quality, necessity and affordability.”

Prinsloo said that this drop in expectations could be a precursor to more significant numbers of people opting out entirely or downgrading their benefits to basic core plans in the coming months, as they don’t perceive their current use as meeting their requirements or being reliable in their time of need.

There is a definite disjoint between quality and value versus price paid, she said.

“This trend of downgrading – or opting out – is already putting the funding model of medical schemes under pressure. Medical schemes operate on the principle of ‘social solidarity’ where all members within a scheme contribute equally to a pool of funds, whether young and healthy or elderly and sickly, expecting that they will all derive equal utility value from the scheme.

“The latest index shows that the healthy and younger members with lower or even minimal benefit utilisation are least satisfied and loyal.”

Without focused intervention from medical schemes to address the drivers of customer satisfaction in this critical demographic, medical schemes will soon find that the pool of funds to subsidise older, less healthy, higher utilisation members is shrinking, bringing the sustainability of the entire private healthcare funding model into question, she said.

Pricing 

South Africa’s regulatory framework for the private healthcare sector also holds significant implications for customer satisfaction, and very few consumers have a grasp of the inner workings of private healthcare funding models.

Private healthcare costs from 2000 to 2012 doubled in real terms, and by 2028, they will have doubled again on the current trajectory.

Medical schemes carry the bulk of these costs, and unlike the pharmaceutical industry, there is no pricing regulation on healthcare provider tariffs. In the case of prescribed minimum benefits (PMBs) – a list of conditions stipulated by the Medical Schemes Act that all medical schemes must cover at cost – it means that medical schemes have to pay these tariffs no matter what the healthcare provider charges.

With South Africa facing a dire shortage of healthcare professionals, this also means that most providers charge at rates way above inflation and way above what is sustainable for medical schemes or consumers.

Medical schemes have established provider networks to manage these hyperinflationary costs and capped the benefits that members can claim for on lower-cost options (outside of PMBs).

“Today, medical schemes and their members are between a rock and a hard place,” said Ineke.

“Members cannot rely on an overburdened and under-resourced, parlous public healthcare sector, so having some form of medical scheme benefit is a necessity, and a grudge one at that. In a bid to keep up with the healthcare hyperinflation and high utilisation of benefits, medical schemes are left with little choice but to increase costs every year to keep pace and reduce the benefits by offering less comprehensive, core options at more affordable premiums.

“While medical scheme contributions increase every year to keep pace, the reality is that the benefits for the members are decreasing,” she said.

“This means that members not only pay more for their medical scheme benefit but also have to shell out more for co-payments, out-of-pocket healthcare costs and penalty fees, especially if they do not use a network/contracted healthcare provider – this is most prevalent among more affordable, lower benefit options taken up by younger, healthier members,” said Ineke.


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The best and worst medical aids, according to South Africans