The best medical aid schemes in South Africa

Consulta has published its latest South African Customer Satisfaction Index (SAcsi) for the local medical aid industry, showing which of the top five largest medical schemes are keeping their customers happy.

The SAcsi looks at the overall level of satisfaction of customers of South Africa’s medical scheme providers, and for the 2019 ranking, 1,707 medical scheme members were polled across five of the leading schemes by membership numbers – specifically Bonitas, Discovery, GEMS, Medihelp and Momentum.

GEMS is the only closed medical scheme included in the survey.

Customers of all medical schemes polled in the 2019 Index indicated that they do not believe that the premiums paid match the quality of cover and experience on offer, Consulta said.

“Across the board, the industry is struggling to meet the needs of customers in terms of benefit design that meets the needs of customers in a simple and transparent manner.

“No outright leader was identified in this year’s index, with Bonitas and Discovery obtaining a joint leadership position, Medihelp coming in on par with the industry average (72.9) while Momentum is just below par and GEMS lagging in last place,” it said.

Medical schemes are facing huge pressure in a low growth market where customer expectations and utilisation are very high and rising, while loyalty is on the decline as a result of lower price tolerance,  it said.

“As the economy bites and more consumers opt to downgrade their cover to lower benefit options in a bid to cut costs, they are not realigning their ‘consumption-based’ expectations and are struggling to decipher the complexity of benefit options and scheme rules.”

According to rofessor Adré Schreuder, SA-csi founder and chairperson, the strongest predictors of satisfaction in the medical schemes sector is the degree to which customers feel that their healthcare cover provides peace of mind and their provider delivers as they were led to believe.

“It is notable that customers complain most often about the detail and performance of their cover, the related fees and costs, additional out-of-pocket co-payments, and for claims not being covered in particular when it comes to chronic medication,” he said.

Schreuder said that the reality of the private healthcare system is that it is a “minefield” for consumers to understand, fraught with industry jargon, complex benefit designs and scheme rules which make direct comparisons onerous, if not impossible at best.

“And it is this complexity that leads to customer dissatisfaction as members simply do not fully understand the scope of their cover, and what they are liable for in event of a claim.

“Satisfaction levels for medical schemes are substantially lower than those measured in other financial services industries – one of the key reasons is that the overt complexity of benefit designs does not allow for easy cost versus value correlations,” he said.

Grudge purchase

Another point of contention is the fact that annual private healthcare increases have been well above, if not double inflation, for more than two decades which has steadily eroded the benefits that consumers can afford, with many forking out as much as 20% of their monthly income for medical aid.

In response, consumers have opted to downgrade to more affordable benefit options, Schreuder said.

“Medical schemes responded by introducing many more affordable benefit options, but this diversity has in turn created more complexity, making the advice process more challenging and more specifically, benefit designs are open to greater risks of misinterpretation by consumers.

“Few consumers accept, without significant counsel and advice, that a downgrade in benefit option equates to a commensurate downgrade in the reality of what you are covered for, especially when it comes to out-of-hospital costs, co-payments and primary healthcare provision.”

Schreuder said that in many instances, knowing what you are not covered for is as important, if not more, than knowing what you are covered for.

“It is this education and unrealistic expectations gap that medical schemes need to address if they are to halt the growing discontent and cognitive dissonance that consumers feel towards their medical scheme providers.

“While consumers accept that they need and want medical aid cover given the parlous state of public healthcare, it’s still a significant grudge purchase until needed,” he said.


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The best medical aid schemes in South Africa