The number of South Africans belonging to medical schemes overshot the 9m mark for the first time in 2022, but rapid population growth means membership remains unattainable for a growing share of the population, shows research released by the industry regulator last week.
The age of members also rose, according to the Council for Medical Schemes (CMS), with the average age of members rising to 34 in 2022 from 33.6 the year before, while the pensioner ratio also increased, rising from nine in 2021 to 9.3 in 2022. An ageing population is concerning, because it is associated with more illness and higher healthcare costs.
The CMS’ preliminary industry report showed the share of the population belonging to medical schemes shrank to 14.92% in 2022, down from 16.5% in 2000, mainly due to SA’s high unemployment rate and the increasing cost of private healthcare, reports BusinessLIVE.
There were 9.04m medical scheme beneficiaries in 2022, a modest 1.1% increase on the 8.94m lives covered in 2021. Population growth averaged 1.8% a year between 2011 and 2022, according to Stats SA.
Membership growth was reported in restricted schemes, which are limited to specific professions or employer groups, and open schemes, available to anyone who can afford their premiums.
Closed schemes grew from 4.11m to 4.18m lives between 2021 and 2022, while open schemes grew from 4.83m to 4.86mi beneficiaries over the same period.
Industry consolidation continued, with the number of medical schemes declining from 75 to 72 in 2022.
The sector reported a net healthcare deficit of R6.16bn in 2022, a marked swing from the R820m surplus reported in 2021.
While schemes deliberately drew on the reserves they accumulated during the Covid-19 pandemic to hold down contribution increases for 2022, they appear to have faced higher-than-anticipated claims as demand rebounded.
Claims fell during the pandemic as elective procedures were deferred and patients avoided healthcare facilities for fear of infection, allowing many schemes to accumulate reserves and keep contribution increases below CPI in 2021 and 2022.
Medical schemes had previously reported a significant decline in cancer screening during the first two years of the pandemic, warning at the time that this could lead to higher costs in the future.
There was also increased healthcare utilisation in 2022, with the average risk claims per beneficiary per month increasing 5.97% to R1 824.54, compared with R1 738.73 in 2021.
For every R100 received in contributions, schemes paid R93.96 in claims and R8.96 in non-healthcare expenditure, and drew R2.92 of reserves, CMS data show.
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