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.In 2014 Lowveld Hospital, an independent, privately owned hospital, entered into negotiations with Life Healthcare for a proposed merger, pending permission from the competition commission. 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.Ī 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. 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. 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. 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. “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. Overall satisfaction with network plans is also lower. It found that the network option is not perceived as good value relative to comprehensive or hospital plans. SAcsi looked at satisfaction with the three types of medical plans: comprehensive, network schemes and hospital plans. “The low value-for-money perceptions for these two brands likely influenced their position in the SAcsi,” said Schreuder.
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. “Medical aids should remember that healthcare policies are a grudge purchase and therefore take a closer look at improving perceived value,” he said. Adré Schreuder who is the founder of SAcsi and CEO of Consulta Research. “The results show that not a single scheme is meeting the expectations of its customers”, said Prof. 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.
There was a minimum of 298 respondents per company. The companies included in the medical aids survey were Bonitas, Discovery Health, Liberty Health, Medihelp and Momentum Health based on their market share.
Healthcare policies a grudge purchaseĪ sample of 3,297 medical aid policyholders took part in the study through telephonic and web-survey methods in late 2014.Ĭustomers 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. This is according to the latest South African Customer Satisfaction Index (SAcsi) survey. Not a single medical aid is meeting the expectations of policy holders.
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