Ten of the highest member claims paid by Discovery Health Medical Scheme (DHMS) in 2024 totalled R70.5m, the highest (R9.6m) going to a 75-year-old member for “care for (the) long-term use of a ventilator”, reports Moneyweb.
To fund this claim, it would take a theoretical 283 years’ worth of contributions (nearly 3 400 months).
The company said half of the top 10 claims were for the long-term use of a ventilator, with the youngest patient being a new-born (the second youngest was 16).
DHMS says 2 108 individuals claimed more than R1m in the year.
It paid a total of R45bn in hospital claims last year, with a total of 714 000 hospital admissions. Of these, 35 000 of its members and beneficiaries were admitted to ICU.
In total, it paid R83bn in claims expenditure in 2024. A third (32%) was day-to-day, 4% was for chronic medication, 2% for maternity-related claims and 8% for oncology (nearly R7bn).
Scheme members made 2.3m specialist visits in 2024, with 10.6m dispensaries of over-the-counter and 14.2m of prescribed medication.
There were 28 000 babies born, 121 000 mammograms and 209 000 prostate checks conducted, with 435 000 health checks done across its members.
Chronic conditions
DHMS says that of those with chronic conditions, 51% have one, 22% have two, 15% three and 12% four.
The overlap between chronic conditions such as cardiovascular, diabetes, oncology, and mental health “leads to increasingly complex care needs”. A member with a chronic and mental health condition is 3.5 times more at risk of admission than one with no chronic condition, it said.
It has a number of care programmes for these conditions, the largest of which is cardio care (216 000 members), followed by oncology (101 000) and HIV (82 000). In total, more than 1m members benefit from these tailored programmes.
Moneyweb article – Top 10 Discovery medical claims paid in 2024 totalled R70m (Open access)
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