Lifestyle diseases and excessive consultant control are contributors to medical inflation – apart from poor regulatory control of the private sector, which leads to excessive consultant tariffs, coding by healthcare providers for treatments that are more expensive than clinically required, and a lack of low-cost medical benefits.
This is evidenced by claims to the Discovery Health Medical Scheme, with chief clinical officer Noluthando Nematswerani saying their data show that the average age of members increased from 32.3 years in 2008 to 36.8 in 2023.
Also, twice as many young people suffer from chronic conditions compared with 15 years ago.
Chronic claims increased from 15% to 28% between 2008 and 2023, while 9% more people died with comorbidities over the past 12 years (rising from 39% in 2011 to 48% in 2023).
Nematswerani told BusinessLIVE that members were switching to more affordable plans with fewer benefits and lower costs, which often don’t cover high-cost treatments.
High-end comprehensive benefit plans have seen a decline, according to the data, but midrange plans with hospital benefits continue to grow, though more slowly.
Experts in medical funding say inflation and government inaction weaken medical aids ahead of the National Health Insurance (NHI) scheme.
Nematswerani said leading funders were concentrating their efforts on creating more affordable access to quality care. “Even with NHI you must have sustainable benefits and care. The public healthcare service needs to get this right, plus include private sector expertise.” She described NHI as “a long-term journey”.
Many health economists and expert observers predict 20 years to full implementation.
“We’re hoping that there will be a meeting of minds and eventually both sectors can work together,” she added.
BusinessLIVE article – What’s driving up medical inflation? (Restricted access)
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