Medical schemes run on a community-rated system, which means open enrolment where anyone can join an open scheme and regardless of your health status or age, everyone pays the same contribution for a particular plan. The Council for Medical Schemes annual report for 2023/24 released earlier this month shows about nine million members belong to about 71 registered schemes.
However, trends have seen younger potential members gravitating towards medical insurance, which is relatively cheaper than belonging to a traditional medical scheme. Medical insurance is typically offered by an insurer, which owns the funds used to make payouts to members and, unlike a medical scheme, does turn a profit at the end of the year.
Examples of medical insurance would be TymeHealth or Dis-Chem Health.
Read more: Medical schemes vs health insurance — be sure you know the difference
Move towards preventative health measures
The country’s largest medical scheme, Discovery Health, has seen massive benefits from its Vitality rewards programme, which incentivises members to move more for financial rewards. During the Covid years, medical scheme usage dropped and reserves increased. While several schemes took advantage of this to offer members lower contribution increases, Discovery Health also launched a Wellth Fund, which offered families access to health screening benefits over the course of 2023 and 2024.
“The first reason for the Wellth Fund was that we had seen a reduction in screening and prevention activity during Covid. However, it also established a set of data on the underlying health status of medical scheme members, and that data is incredibly important in terms of enabling us to help members improve health span and lifespan,” Dr Ron Whelan, chief executive of Discovery Health told Daily Maverick. The Wellth Fund represents an investment of R600-million to R700-million a year.
As the Wellth Fund programme winds to a close at the end of this year, Discovery Health is now launching a new programme from January – Personal Health Pathways. Whelan says the Personal Health Pathways programme will tap into all the data available across the Vitality ecosystem. “That’s a massive data set. We are applying machine learning and artificial intelligence to extract the optimal healthcare pathways for every single member of the Discovery Health Medical scheme – regardless of whether they are on Vitality or not,” he says.
Whelan compared the programme to someone using Google Maps to get to their destination using the fastest, safest route. “Effectively, we’ve done the same thing for healthcare. We’ve figured out the most effective route to the longest health span and lifespan, and we’ve created individualised and personalised health pathways for 2.2 million adult Discovery Health members,” he says.
Wellness and preventative benefits on the rise
Compcare is offering a whopping R40,000 in wellness and preventative benefits per member, addressing the rising consumer demand for health and financial prudence. As healthcare consumerism grows, individuals seek options beyond emergencies, focusing on overall wellbeing and prevention – a trend highlighted by McKinsey’s 2024 Global Wellness Report.
“With consumers prioritising wellbeing more than ever, our strategy meets these evolving needs, catering to a generation that values proactive health management,” says Josua Joubert, chief executive and principal officer of CompCare.
Lee Callakoppen, principal officer of Bonitas, pointed out that roughly half of the population has high blood pressure. “The latest international treatment protocols recommend self-monitoring to help individuals manage their blood pressure more effectively. In keeping with this, a blood pressure monitor will be funded over a two-year cycle per family,” he said.
Bonitas has extended its preventative measures to the elderly, offering wellness screenings, vaccines for flu and pneumonia, age-appropriate screening for prostate, breast and cervical cancer, osteoarthritis screenings, coordination of care with a nominated GP, chronic care management and support and fall-risk assessments to allow seniors to live independently. DM