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Rock Of Ages

ARTICLE BY

  • Leo Dlamini
  • Chief Executive Officer and Principal Officer
  • Bestmed Medical Scheme

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As Bestmed celebrates 60 years in South Africa’s medical aid industry, we look at what’s worked in the past, the current state of the industry and what the future may hold.

Medical cover in South Africa has been available in various forms for over 100 years. It is said that the first medical scheme was established in South Africa during 1887, namely the Kimberly Central Company Benefit Society. It is worth noting that over the years, medical schemes have evolved from merely processing and paying claims to becoming genuine knowledge-based entities that are able to plan, manage and deploy strategies to enhance value for stakeholders. This evolution increasingly relies on technological advancement, rules-based systems, critical clinical and administrative skills, setting and contracting targets that are achievable, and institutional knowledge.

As time has passed, the medical aid industry has faced consolidation, reliance on information technology and increasing complexities, ranging from rapid changes in the environment that have outpaced regulations to technological and clinical developments, escalation of health-service needs, increasing costs of issues related to fraud, waste and abuse.

Looking at the industry’s more recent history, its growth has been stagnant for an extended period, while the prevailing economic circumstances in South Africa continue to pose challenges to the long-term sustainability of the industry.

Current state of play

Currently the industry is dealing with the post Covid-19 surge in claims, along with their complexity and higher utilisation. This has led to higher costs which have to be funded through reserves and increased contributions, impacting the solvency ratio of schemes and affordability for members.

Despite this outlook, and in the spirit of innovation, industry players such as Bestmed, are driving preventative care measures, and focusing on wellness programmes and health screenings, with the aim of reducing long-term costs and improving patient outcomes.

The industry is poised to play a crucial role in universal healthcare in the near future. Our country needs a robust healthcare sector to ensure that both the young and old, healthy and sick, have the assurance that they are well cared for and in good hands.

The emergence of primary healthcare insurance products entering the market presents a missed opportunity for the private healthcare sector to fully participate and support the government’s universal healthcare aspirations. These products differ from medical aid offerings in South Africa and are subject to different regulation.

The products are offered at a lower price point and do not cover the industry’s Prescribed Minimum Benefits which cover trauma and other life-threatening health events. Instead, they cover very specific events and also differentiate pricing based on the perceived risk profile of the holder.

The industry is also experiencing increasing healthcare costs, which renders medical scheme membership unaffordable for many citizens. Balancing the rising costs of healthcare and affordability for members is delicate and a critical aspect of running a sustainable medical scheme.

Looking ahead

Looking to the future, the emphasis will be on sustaining growth, containing costs and advancing technology. Alongside these, the ability of medical schemes to excel in service and fulfil their service commitments will be crucial.

At Bestmed Medical Scheme, we have demonstrated over the last six decades that a medical scheme in the private healthcare sector can rise above these challenges. Bestmed has always, and will continue, to strive to be a reliable partner through challenging times, as well as in fulfilling the trusted role of funding its members’ healthcare needs.

Bestmed understands the importance of leveraging technology to enhance member value propositions through digital transformation, data analytics and artificial intelligence (AI). Our focus is on implementing systems that support client-centric measures and advancing our security management tools. Cybersecurity and the protection of member data are top priorities, as we remain committed to safeguarding members’ personal information and preventing security breaches.

As it celebrates 60 years in South Africa’s medical aid industry, Bestmed attributes its success and extends its gratitude to all its past and current employees, who have contributed to its achievements, recognition and expansion. Equally, the organisation owes a similar debt to its members and its healthcare advisor community, who have consistently shown faith in the scheme as a reliable partner, through both challenging and prosperous times.

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