Rising cost of medical aid requires urgent attention

The relentless rising cost of medical aid requires urgent attention as South Africans grapple with yet another financial challenge.

Over the past decade, the cost of medical aid premiums and out-of-pocket expenses has surged, placing immense pressure on individuals and families.

This trend is not only troubling for consumers but also poses significant implications for the broader healthcare system and the economy, Shaun Meintjes, franchise principal and financial adviser at Consult by Momentum, says.

“One primary driver of the escalation of medical aid costs is the rising prices of medical services and treatments.

“Advancements in medical technology, while beneficial, come at a high cost. New diagnostic tools, surgical procedures and treatments are often expensive and these costs are passed on to consumers.

“The increasing burden of chronic diseases, such as diabetes and hypertension, also requires ongoing and costly management, further driving up expenses.”

Meintjes says the ripple effect of these increasing costs is profound.

“Many South Africans find it increasingly difficult to afford comprehensive medical aid coverage and this has led to individuals downgrading their plans or opting out of medical schemes entirely.

“Those who downgrade their plans may find themselves inadequately covered in times of medical need, facing high out-of-pocket expenses that can be financially crippling.

“Those who leave medical aid schemes altogether must rely on the public healthcare system, which is already under significant strain.”

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Higher medical scheme costs consumes more household income

In turn, he points out, as medical aid premiums increase, they consume a larger portion of household income, leaving less money available for other essential needs such as education, housing and savings.

“This is particularly concerning in a country like South Africa, where many households are already struggling. Wage growth has not kept pace with the increase in medical aid costs, widening the affordability gap.”

 Employers are also feeling the pinch, Meintjes says. Many companies provide medical aid benefits as part of their employee compensation packages but the rising cost of these benefits is becoming unsustainable.

“Employers face difficult choices: absorbing the higher costs, passing them on to employees, or reducing coverage. Absorbing costs can strain company finances while passing them on to employees can lead to dissatisfaction and decreased morale and reducing coverage can leave employees vulnerable to high medical expenses. It is a lose-lose situation.”

He says the implications for the healthcare system are also significant.

“As more people downgrade their plans or leave medical aid schemes, the risk pool within these schemes becomes less healthy. This leads to a vicious cycle where costs continue to increase, prompting more people to leave and further driving up premiums for those who remain.”

Increased reliance on the public healthcare system places further strain on already limited resources, potentially compromising the quality of care, Meintjes says.

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Multi-faceted approach needed to tackle rising medical aid costs

“Tackling rising medical aid costs requires a multi-faceted approach. Policymakers must work closely with medical aid providers, healthcare providers and other stakeholders to find sustainable solutions.

“This could include regulating the pricing of medical services, promoting cost-effective healthcare practices and ensuring that medical aid schemes provide adequate coverage without becoming prohibitively expensive.”

Meintjes believes there is also a need for greater transparency in the pricing of medical services and the operations of medical aid schemes.

“Consumers should be empowered with the information needed to make informed decisions about their healthcare coverage. Education and awareness campaigns can also play a role in helping people understand the importance of maintaining adequate coverage and managing their health proactively to avoid costly medical interventions.”

He emphasises that the rising cost of medical aid is a pressing issue that requires urgent attention.

“Ensuring that healthcare remains accessible and affordable is not only a matter of financial stability but also a fundamental aspect of social equity and well-being.

“It is time for all stakeholders to come together to address this challenge and secure a healthier future for all South Africans.”