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Discovery pays R10bn in claims

Cape Town - Between August last year and July this year Discovery Health settled the most claims for gastroenteritis, pneumonia, digestive problems, caesarean sections and cataract operations.

The medical insurer paid out R10.24bn worth of claims over this period.

This research relates to the 2.14m members under Discovery Health's wing. The entire medical fund industry has just more than 8m members, and Discovery's information is consequently a good indication of how medical scheme members' contributions are spent.

Gastroenteritis topped the list with 25 283 hospital admissions, followed by caesarean sections with 24 038. The latter is more than double the 9 976 normal births over the period.

Discovery also had to pay for almost 15 000 tonsillectomies and 4 000-odd circumcisions.

The most expensive conditions included heart and lung transplants, at an average of R520 333 each, as well as liver and bone-marrow transplants averaging R442 846 and R288 775 respectively.

Expenditure on premature babies is also huge, and is - according to the baby's weight - frequently on the list of the most costly.

Average expenditure in the months under review for a premature baby weighing less than 1 000g and requiring major surgery is, for example, R483 834.

The biggest payments to hospitals were for members suffering from pneumonia, with an average age of 60 and spending 48 days in the hospital. The associated costs amounted to R2.157bn.

In July this year Discovery had to handle 2 362 emergencies, 646 of which occurred overseas. Between August 2008 and July this year there were 31 412 emergency situations, 5 929 of which occurred outside the country's borders.

According to Discovery, hypertension is the medical condition that requires the most chronic medication, with 174 255 members registered for the disease.

But it appears that people are taking preventive action and having themselves tested for problems like cancer, sugar diabetes and heart conditions. Most of the tests performed were for glucose, cholesterol, hypertension and HIV, as well as pap smears.

- Sake24.com

For more business news in Afrikaans, go to Sake24.com.

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