Johannesburg - The local medical scheme sector could be ripe for consolidation, bringing many opportunities for players in the market, says Bonitas Medical Fund executive director Katy Caldis.
Bonitas is responsible for approximately 252 000 families or 600 000 lives (or beneficiaries) of the 7.5 million covered by medical schemes, with 8% market share. SA's biggest medical scheme, Discovery Health, is responsible for approximately 926 451 families (as measured by the number of principal members).
Bonitas is unlisted as it is a fund as opposed to an adminstrator; funds are not allowed to list according to law.
According to Caldis, consolidation has partly been driven by the Government Employee Medical Scheme (Gems), which has seen public sector medical scheme members moving away from their original schemes and into Gems.
She said some small schemes were becoming unviable as their members who work in the public sector were opting for GEMS, the result being a significant increase in costs for the smaller schemes. "It puts pressure on them financially," she said.
Cadiz African Harvest portfolio fund manager Rajay Ambekar agreed that consolidation was hotting up, saying that bigger schemes had been making acquisitions.
One example is Discovery Health parent Discovery Holdings' new health insurance division PruHealth, a joint venture with Prudential plc in the United Kingdom, which Discovery Holdings said was an "important initiative" for the group.
"I'd expect to see this [trend of consolidation] to continue into the future," said Ambekar.
He said scale was a major factor for administrators; the larger the scheme, the lower the cost for its members.
Changing behaviour
Caldis said that economies of scale help to keep non-healthcare and administrative costs low.
"Affordability and accessibility are the main barriers to growing a fund, so the key is to find ways to make it more affordable and accessible," she said, adding that this would be done by attracting more people to join the fund.
But it's only the people who need cover immediately who see value in joining a fund, while the healthy or young don't feel that they need to be covered.
"The biggest challenge is changing this behaviour, because an accident can happen and things can go wrong," said Caldis.
She said that medical schemes also find an ageing population of members a challenge. "The key is to find a younger population."
At 29.1 years, the average age of Bonitas' members is lower than the industry average of 31.4 years, but Caldis said that as a fund's membership grows, the average age of members tends toward the industry average.
For example, if the average ages of four people now were calculated in a year's time, then the average age of those four people would be what it is now, plus a year. This shows that the members are getting older.
However, if a younger person were added to the group after the average ages of the four people were calculated, then the average age of the five people in a year's time would be lower than what it is now, which shows the average age of the five people is actually getting younger.
"Our goal is for the fund to age by less than half a year every year, so that there is a constant flow of younger people joining as members," she said.
- Fin24.com