Medical schemes: can’t live with them, can’t live without them

Medical aid members acknowledge that they need medical scheme benefits, but this does not mean that they do not view it as a significant and expensive grudge purchase. And those who complain the most are members with low to minimal benefit use who have to pay out of their own pockets for their primary healthcare needs and chronic medication.

These were some of the key findings in the latest South African Customer Satisfaction Index (SA-csi) for Medical Schemes (2020) conducted by Consulta, which provides insights into the overall satisfaction of members of South Africa’s largest open medical scheme providers; Bestmed, Bonitas, Discovery, Medihelp and Momentum. GEMS is the only closed medical scheme included.

A total of 1826 medical scheme members participated. Other key findings were:

• Quality experience: Discovery, Medihelp and Bestmed delivered, with GEMS showing improvement and Momentum struggling.
• Perception of value for money: Bestmed and Medihelp lead, while GEMS and Momentum scored well below the rest. Discovery is perceived as the more expensive brand.
• Customer satisfaction: Bestmed scored the highest at 77,4%, followed by Medihelp at 77,1%, Discovery at 76,8%, Bonitas at 74,9%, GEMS at 71,1% and Momentum on 71,1%.
• Customer expectations and perceived quality: none of the brands reached expectations, but Bestmed and Medihelp came closest to closing the gap, with GEMS and Bonitas having some way to go.
• Perceived value: Bestmed took the lead by a significant margin while Medihelp was also in a leading position. Bonitas and Discovery’s performance were on par, with GEMS and Momentum below par.
• Complaints were mostly about detail and performance, related fees and costs, additional out-of-pocket co-payments when claims are not covered and their chronic medication not covered. Bestmed (26%), Discovery (24%) and GEMS (23%) have the most complaints about fees and charges, above the industry average of 22%.
• Customer loyalty: Bestmed had the most loyal customers at 70,6%, followed by Medihelp at 70,4%, Discovery (69,9%), Bonitas (68.2%), Gems (60%) and Momentum (59.5%).
• Likely to recommend the fund: Bestmed members were the most likely with a score of 32.3%, with Bonitas at 26.3%, Medihelp at 21.4%, Discovery at 21.4%, Momentum at 13.3% and GEMS at -6.0%.
• Fair treatment: Medihelp members (83.2%) feel that their scheme treats them fairly, followed by Bestmed (82.8%), Bonitas (81.6%), Discovery (80.0%), GEMS (77.6%) and Momentum (79.0%). This score was made up of responses about fair treatment, products and services that address customer needs, transparent and easy to understand information, advice suitable to the customer’s circumstances, products and services delivered as expected, ease of interaction, and whether customers are treated with respect.

Although schemes charge the same contributions for all beneficiaries, irrespective of health status or age and therefore should derive equal utility value from the scheme, trends observed over the last five years show a distinct skew in the satisfaction of members who use their benefits for once-off, sizeable medical expenses such as hospitalisation or chronic healthcare needs, compared to those who primarily use the scheme benefits to fund day-to-day claims, such as GP visits, optometry and dentistry.

“The co-payments on day-to-day benefits represent out-of-pocket expenses that, within a pressured consumer budget, detract significantly from the utility value of medical schemes,” explains Ineke Prinsloo, head of customer insights at Consulta.

“Results from our ongoing Covid-19 tracking studies indicated that consumers are looking towards cutting back on expenses and discretionary spending as a result of the pressure on household budgets. With concerns about healthcare right up there with the economy’s state and the ability to earn an income, consumers are reluctant to cut their medical scheme contributions.”

She says the index showed that customers want individual, modularised product and service solutions that meet their specific needs now, but this is impractical because a medical scheme benefit must cover a wide basket of regulated prescribed minimum benefits at a fixed cost, regardless of whether members use them or not.

“Medical scheme members still demand curated choices on their medical scheme benefits, which is challenging on a model that is both unpredictable and relies on cross-subsidisation. While medical schemes have created lower benefit options to provide greater affordability and flexibility, it has created more complexity and has made the advice process incredibly challenging.”

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