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ARTICLE BY

  • Dr Ron Whelan
  • CEO
  • Discovery Health

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Personalised, tailored offerings developed to address the different needs of different types of customers will be key to driving behaviour, and to the sustainability of the industry. Here are ways Discovery Health Medical Scheme is working to prioritise members’ wellness.

Discovery Health Medical Scheme continues to demonstrate strong performance, financial certainty and sustainability for members’ peace of mind. Despite economic volatility, changing demographics, and affordability constraints, Discovery Health Medical Scheme has focused on members’ interests by launching new benefits, particularly in relation to health promotion and disease prevention, enhancing benefits to assist members in funding their healthcare needs, maintaining the Scheme’s strong financial solvency position, maintaining the Scheme’s leading position and market share.

The Scheme’s operational performance has remained robust, and this has yielded exceptional results, supporting members’ health needs while ensuring the Scheme’s sustainability. Discovery Health Medical Scheme aims to grow its young and healthy member base, and as of December 2023, it had 2 788 242 beneficiaries, representing 57.8% of the open medical scheme market in South Africa.

To sustainably keep up with costs of claim escalations, medical schemes base annual contribution increases on prevailing medical inflation – the year-on-year increase in the cost of healthcare claims for a medical scheme. Medical inflation is influenced by the following increases in tariffs and utilisation:

Tariff or price increases: i.e. the annual increase in the cost of a claim for healthcare services (e.g. the cost of a visit to the doctor). For Discovery Health Medical Scheme, tariff increases are in line with Consumer Price Inflation year-on-year.

Increasing demand for healthcare services: as medical scheme members age and more members are diagnosed with chronic illnesses. As a result, their number of claims for healthcare services increase (over and above the annual increase in the prices of those healthcare services). This means that medical schemes experience a higher volume of claims for the same population every year, based on this increasing demand.

Factors which increase the cost and volume of healthcare services: in the supply of healthcare (i.e. affecting care provision). These include new medical technologies, new procedures, new facilities or even new treatments for some of the dreaded diseases, like cancer, which replace existing treatments but at a higher cost.

Benefits derived from risk management and Vitality: Over time, Discovery Health has implemented various unique risk management and wellness interventions to reduce medical inflation for Discovery Health Medical Scheme. These interventions lead to lower contribution increases or enhanced benefits for Discovery Health Medical Scheme members.

Precise and personalised healthcare revolution

Precise and personalised healthcare is set to revolutionise the formation of healthy habits and sustain behaviour change among Scheme members.

From January 2025, 2.2 million adult members on the Discovery Health Medical Scheme will gain access to Personal Health Pathways through the Discovery Health App and via a bespoke WhatsApp journey. Personal Health Pathways offers each member a precise and personalised health journey based on their unique healthcare needs, dynamically adapting as the member’s health status evolves. Members are rewarded for completing personalised health and exercise actions and developing sustained healthy habits over time.

The Personal Health Fund will provide all members with additional risk-funded benefits of up to R10 000 per policy to spend on day-to-day medical expenses.

All members of Discovery Health Medical Scheme will also have access to an exciting new category of benefits through the Personal Health Fund, effective from 2025. Through their Personal Health Fund and depending on the member’s chosen plan and family composition, members can access up to R10 000 in risk-funded benefits for day-to-day medical expenses each year. Members can accumulate funds in their Personal Health Fund by completing health actions recommended in their Personal Health Pathway. The Personal Health Fund significantly enhances existing benefits that members have for day-to-day medical expenses, ultimately improving their access to care and their overall health status.

Meeting the needs of young professionals

Young professionals have distinctive healthcare needs, and they often invest time researching affordable plans that provide benefits they need most. Research conducted by Discovery Health highlights the financial barriers faced by young adults when considering medical aid coverage. Medical scheme contributions make up a larger share of income for younger people. Discovery Health data analysis shows that for members aged 20-29 approximately, 7% of their income goes toward medical scheme contributions, whereas for older working adults approximately 4% or lower of their monthly income goes toward medical scheme contributions.

Discovery Health Medical Scheme has introduced a new medical scheme plan, Active Smart, aimed at addressing the healthcare needs of new entrants and young professionals. Launching on 1 January 2025 and subject to approval by the Council for Medical Schemes, Active Smart will be the most affordable medical scheme option in the open medical scheme market, offering a tailored benefit package for individuals starting out in their careers. The new plan is priced at R1 350 per principal member per month.

The Active Smart plan addresses five core healthcare priorities identified as being most important to young professionals:

Preventive care: Coverage for routine health check-ups, pap smears, and annual flu vaccinations for at-risk members through the plan’s Screening and Prevention Benefit, as well as the Personal Health Fund. Discovery Health Medical Scheme has seen a 23% increase in the prevalence of hypertension among younger members since 2019, underscoring the importance of preventive care.

Mental health support: Access to the Discovery Health Medical Scheme Mental Health Care Programme, which includes consultations with a Premier Plus GP, antidepressant medications, psychotherapy, and online Cognitive Behavioural Therapy and gives members access to tools and benefits to monitor and manage their condition. Claims for mental health conditions have increased, with one in seven young adults now claiming for such conditions, compared to one in 20 in 2013.

Emergency cover: Full coverage for emergencies in any private hospital and unlimited access for planned admission to the Dynamic Smart Hospital Network, subject to a fixed deductible.

Dental and eye care: The plan offers an annual eye test with a network optometrist for R125 and a dental check-up for R190.

Over-the-counter medicines: Members can obtain over-the-counter medication and contraceptives through the pharmacy network. Members can also utilise their Personal Health Fund to supplement their day-to-day medical expenses.

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