South Africa Medical Aid Funding Industry Report 2022: Effects of the Pandemic and Recovery, Membership and Claims Trends and the Development of the NHI

17 Jan 2023
www.prnewswire.com
DUBLIN, Jan. 17, 2023 /PRNewswire/ -- The "Medical Aid Funding in South Africa 2022" report has been added to
ResearchAndMarkets.com's offering.
This report on medical aid funding in South Africa includes information on the effects of the pandemic and recovery, membership and claims trends and the development of the NHI. There are profiles of 30 companies including the major government scheme GEMS and major private sector players such as Discovery, Momentum and Bonitas.
South Africa has a two-tiered, and highly unequal, healthcare system, with most of the population being state-funded. While only 14.86% of the population can afford private healthcare sector, the high costs are making it increasingly difficult for some people to continue.
Government plans to implement National Health Insurance (NHI) to fund healthcare in the public and private sectors, with most of the funding coming from general taxes and contributions of people earning above a set amount.
The process, which began in August 2011, has been slow, and the NHI Bill is still under consideration in the National Assembly. The private sector has raised concerns about its affordability, and the state's ability to implement it effectively and competently.
Key Issues
Rising and unregulated healthcare costs, an ageing population and the increase in non-communicable lifestyle diseases are key challenges. Average annual consumer prices for medical services and pharmaceuticals continue to increase ahead of inflation and premiums are high, making membership unaffordable for most South Africans.
Fraud, waste, and abuse is a key issue in the industry, impacting around 22% of all claims. Fraudulent activity and abuse includes doctors and medical personnel colluding with members, submission of false claims, over-servicing or over-charging.
Trends
There has been a decrease in the number of registered medical schemes over the past two decades, mainly due to consolidation. Medical scheme membership, however, has increased. Claims declined in 2020 but increased in 2021 as members scheduled delayed elective surgeries.
Changes are taking place in terms of attracting young members and low cost cover, online consultations and predictive and preventative care.
Key Topics Covered:
1. INTRODUCTION
2. DESCRIPTION OF THE INDUSTRY
2.1. Industry Value Chain
2.2. Geographic Position
2.3. Size of the Industry
3. LOCAL
3.1. State of the Industry
3.2. Key Trends
3.3. Key Issues
3.4. Notable Players
3.5. Corporate Actions
3.6. Regulations
3.7. Enterprise Development and Social Development
4. AFRICA
5. INTERNATIONAL
6. INFLUENCING FACTORS
6.2. Economic Environment
6.3. Input Costs
6.4. Fraud, Waste, and Abuse
6.5. Labour
6.6. Environmental Issues
6.7. Technology, R&D, Innovation
6.8. Government Interventions
7. COMPETITIVE ENVIRONMENT
7.1. Competition
7.2. Ownership Structure of the Industry
7.3. Barriers to Entry
8. SWOT ANALYSIS
9. OUTLOOK
10. INDUSTRY ASSOCIATIONS
11. REFERENCES
11.1. Publications
11.2. Websites
COMPANY PROFILES
Notable Players
Major Open Medical Schemes
Major Restricted Medical Aids
Major Medical Fund Administrators
Major Open Medical Schemes
Bestmed Medical Scheme
Discovery Health Medical Scheme
Fedhealth Medical Scheme
KeyHealth Medical Scheme
Medihelp Medical Scheme
Medshield Medical Scheme
Momentum Health
Sizwe Hosmed Medical Scheme
Major Restricted Medical Aids
Anglo Medical Scheme
Bankmed Medical Scheme
Chartered Accountants Medical Aid Fund
Government Employees Medical Scheme
LA-Health Medical Scheme
Moto Health Care
Platinum Health Medical Scheme
Profmed Medical Scheme
SAMWU National Medical Scheme
Sasolmed Medical Scheme
South African Police Service Medical Scheme
Transmed Medical Fund
Major Medical Fund Administrators
Agility Holdings (RF) (Pty) Ltd
Momentum Thebe Ya Bophelo (Pty) Ltd
Professional Provident Society Healthcare Administrators (Pty) Ltd
For more information about this report visit https://www.researchandmarkets.com/r/vjuc7p
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