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2019 – Customer Satisfaction Index for Medical Schemes Shows Underwhelming Performances



The views expressed in this article are not those of the FIA


Medical schemes are facing tremendous pressure in a low growth market where customer expectations and utilisation are very high and increasing, while loyalty is on the decline as a result of lower price tolerance.  As the economy bites and more consumers opt to downgrade their cover to lower benefit options in a bid to cut costs, they are not realigning their ‘consumption-based’ expectations and are struggling to decipher the complexity of benefit options and scheme rules.

These are just some of the findings in the latest South African Customer Satisfaction Index (SA-csi) for Medical Schemes (2019) conducted by Consulta which provides highly scientific insights into the overall level of satisfaction of customers of South Africa’s medical scheme providers – Bonitas, Discovery, GEMS, Medihelp and Momentum.  GEMS is the only closed medical scheme included in the survey.  Consulta polled 1707 medical scheme members across five of the leading schemes by membership numbers.

Customers of all medical schemes polled in the 2019 Index indicated that they do not believe that the premiums paid match the quality of cover and experience on offer. Across the board, the industry is struggling to meet the needs of customers in terms of benefit design that meets the needs of customers in a simple and transparent manner.  No outright leader was identified in this year’s index, with Bonitas and Discovery obtaining a joint leadership position, Medihelp coming in on par with the industry average (72.9) while Momentum is just below par and GEMS lagging in last place. 

The SA-csi for Medical Schemes is the most comprehensive survey of customer satisfaction in South Africa, and is a causal model that links customer expectations, perceived quality, and perceived value to customer satisfaction (the SA-csi score), which in turn is linked to customer complaints (and recovery), and customer loyalty intentions. 

Key take-outs from the SA-csi for Medical Schemes 2019

Customer Satisfaction – Overall Index

  • Bonitas (75.1) and Discovery (74.8) lead the industry, Medihelp (73.5) come in on par with the industry average score of (72.9), while Momentum scores just below and GEMS with the lowest score at 68.3.  Overall customer satisfaction for the industry has increased to 72.9 compared with 71.6 in 2018.
  • Bonitas and Discovery were the only two schemes to show an improvement on 2018 scores, with Bonitas showing a big improvement of 4.9 index points in 2019, followed by Discovery with 1.7 index points. 
  • Gems (-0.5), Medihelp (-1.6) and Momentum (-1.3) showed a decline on overall customer satisfaction compared with 2018 scores. 
  • While Discovery, GEMS, Medihelp and Momentum have stayed relatively stagnant on overall customer satisfaction scores for the last two years, Bonitas has made a significant improvement in 2019, suggesting that recent strategic reviews of its benefit options and member focus are starting to pay dividends.

Customer Expectations and Perceived Quality

  • Across all brands, customer expectations are not being met consistently.  South African customers have very high expectations of their medical scheme providers (industry average of 80.6) given the fact that it’s an expensive buy and communication around benefits is often not done clearly.  
  • Bonitas and Medihelp are the only two brands that showed a positive gap – albeit marginal – where perceived quality meets customer expectations.

Perceived Value

  • Perceived value is a measure of the quality, relative to the price paid.  The perception of value for money is a very strong predictor of future usage and company growth.
  • In terms of the value index, Medihelp (71.6) takes the lead, Bonitas (70.9), Discovery (70.6) and Momentum (71.4) are all on par with the industry (69.6).  GEMS is below par at 66.1.  Bonitas and Discovery are the only two schemes that saw a marginal increase in Perceived Value score compared with 2018.
  • However, when Perceived Value is overlaid with the Price-Quality alignment, customers of all brands feel that the premiums charged do not match the quality of the cover and experience on offer.  In this regard, Discovery has the biggest gap (-6.2) in Perceived Value and Price-Quality alignment, followed by Bonitas (-5.8), Medihelp (-4.9), Momentum (-3.9) and GEMS (-2.3).

Complaints Incidence and Resolution

  • Of the complaint incidence across the industry, customers complained most about fees and charges (22%), claims issues (19%), terms of cover or scheme rules (13%), feedback (9%) and waiting time (7%).  
  • Discovery and Medihelp have the most complaints about fees and charges, both at 28% and above industry average (22%). 
  • Medihelp has the highest incidence of claims-related complaints at 26% and well above industry par of 19%.
  • In terms of complaints incidence and handling the industry average of complaints incidence is 15.9/100 and complaint handling is 48.6/100.  
  • Discovery has the lowest complaint incidence at 13.2/100 and complaint handling of 51/100. 
  • Bonitas’ complaint incidence is at 14.3/100 and complaint handling of 51.5/100. 
  • While Medihelp has a complaint incidence slightly higher than industry par at 15.8/100, its complaint handling score is well above industry par at 55.7.
  • Momentum and GEMS perform below average in the Complaints Incidence and Resolution category.

Customer Loyalty

  • Bonitas has the most loyal customers at 69.4%, above industry par of 64.0%, and has also seen a big improvement of 7.5% in loyalty score compared with 2018 (61.9%).
  • Discovery, Medihelp and Momentum all saw a decline in customer loyalty scores.

Net Promoter Score

  • Net Promoter Score measures the likelihood of a person recommending a brand. 
  • Bonitas has the highest Net Promoter Score (NPS) at 21.6%, which is well above the industry average (9.5%). Bonitas customers are active promoters of the brand to others, with 45% of customers recommending the brand.  Bonitas also has the lowest number of detractors at 24%.   
  • Compared with 2018, Bonitas has seen a radical increase in NPS score when it came in at a low of 2.6%, suggesting that its focus on benefit simplification and customer satisfaction and complaints handling have had a marked impact on how customers perceive the brand, and their willingness to endorse it to others.
  • Discovery follows with an NPS of 14.5% which is on industry par and marginally up on its 2018 score of 12.2%.  41% of Discovery customers actively promote the brand, and 27% are detractors.
  • The balance of scores see a big drop-off on NPS performance well below industry par – Medihelp (10.9%), Momentum (8.4%) and GEMS (-6.7%).
  • GEMS has a high percentage of detractors at 43%, well above its promoters at 36%. 

Treating Customers Fairly (TCF)

  • The degree to which customers feel they are being treated fairly by their medical scheme is highest with Medihelp (78.2) and Bonitas (78.9) – both above the industry score of 76.2.
  • Discovery follows with a score of 77.1 which is in line with the industry.
  • GEMS (73.6) and Momentum (72.9) are lower than the rest of the industry. 
  • The make-up of the overall TCF score looks at seven key aspects including:
    • Fair treatment of customers
    • Products and services that address customer needs
    • Transparent and easy to understand information
    • Advice that is suitable for the customer’s circumstances
    • Products and services deliver as expected
    • It is easy for customers to claim, change provides, complain or consider other providers
    • Customers are treated with respect and there is an open relationship

According to Professor Adré Schreuder, SA-csi Founder and Chairperson, the strongest predictors of satisfaction in the medical schemes sector is the degree to which customers feel that their healthcare cover provides peace of mind and their provider delivers as they were led to believe. 

“It is notable that customers complain most often about the detail and performance of their cover, the related fees and costs, additional out-of-pocket co-payments, and for claims not being covered in particular when it comes to chronic medication.  The reality of the private healthcare system is that it is a minefield for consumers to understand, fraught with industry jargon, complex benefit designs and scheme rules which make direct comparisons onerous, if not impossible at best.  And it is this complexity that leads to customer dissatisfaction as members simply do not fully understand the scope of their cover, and what they are liable for in event of a claim.  Satisfaction levels for medical schemes are substantially lower than those measured in other financial services industries – one of the key reasons is that the overt complexity of benefit designs does not allow for easy cost versus value correlations,” explains Prof. Schreuder.

Annual private healthcare increases have been well above, if not double inflation, for more than two decades now which has steadily eroded the benefits that consumers can afford, with many forking out as much as 20% of their monthly income for medical aid.  In response, consumers have opted to downgrade to more affordable benefit options.

“Medical schemes responded by introducing many more affordable benefit options, but this diversity has in turn created more complexity, making the advice process more challenging and more specifically, benefit designs are open to greater risks of misinterpretation by consumers.  Few consumers accept, without significant counsel and advice, that a downgrade in benefit option equates to a commensurate downgrade in the reality of what you are covered for, especially when it comes to out-of-hospital costs, co-payments and primary healthcare provision. In many instances, knowing what you are not covered for is as important, if not more, than knowing what you are covered for.  It is this education and unrealistic expectations gap that medical schemes need to address if they are to halt the growing discontent and cognitive dissonance that consumers feel towards their medical scheme providers.  While consumers accept that they need and want medical aid cover given the parlous state of public healthcare, it’s still a significant grudge purchase until needed,” says Prof. Schreuder.

“Products need to be easy to understand and should not cause unnecessary effort to deal with. Staff members need to do their part by showing a high level of product understanding and empathy, taking ownership to resolve issues and providing customers with regular, relevant feedback during any process of interaction. It is very important that customers understand exactly what they are covered for during the sales and annual review process as this is where their expectations are born. The best way to achieve this is to drive simplicity in communication, remove jargon and provide sound advice that eliminates the chances of being disappointed at claims stage,” he adds. 

As a strategic tool for gauging the competitiveness of individual firms and predicting future profitability, an organisation’s customer satisfaction performance, as measured by the SA-csi methodology, provides a predictive indication of how well the firm will perform in terms of future revenue and earnings growth.  Supported by both the scientific and practitioner community, the SA-csi is the first independent, comprehensive national customer satisfaction index with international comparability in South Africa and has collected data from more than 400 000 consumers since its inception in 2012. The SA-csi forms part of a global network of research groups, quality associations and universities that have adopted the methodology of the American Customer Satisfaction Index (ACSI) via its Global CSISM program.