Johannesburg - The majority of medical aid members say their
schemes are too expensive while a minority actually read their member guides,
according to a survey released on Monday.
"Three-quarters of respondents felt that their medical
schemes were too expensive," according to a statement on the findings of
the 2010 OMAC Actuaries & Consultants Healthcare Monitor.
"It seems that members are adopting a 'rather safe than
sorry' approach when selecting medical schemes and options, instead of trying
to improve their understanding. This would exacerbate the feeling that medical
schemes are expensive," said Margaret Hulme, head of healthcare consulting
However, only 44% of respondents had read their member
The survey of 1 002 medical aid members or beneficiaries
found that nearly half did not use their broker, member guides or the internet
to try and improve their understanding of their medical scheme.
"Call centres were the worst-rated area of service,
which might contribute towards members' lack of understanding."
This led to ignorance of what their medical schemes offered.
"According to the survey, one-third of members said
they did not know what they were covered for and that they only find out what
they are covered for once they claim.
"A third of members complained that they found the
benefit structure confusing."
The introduction of cost-saving initiatives may not get the
desired response, such as in the introduction of designated service providers
(DSP), where members get benefits if they use the services of only DSPs.
"Members do not like DSPs. This is not because of any
problem with the concept itself, but rather owing to the perceived lack of freedom
of choice - particularly when it comes to GPs."
She said 84% of members said their scheme offered good value
for money, but they believed that more expensive options with more benefits and
without DSPs provided the best value for money.
Hulme said in reality the options with lower benefits and
using DSPs probably provided better value.
Members surveyed prefer higher monthly contributions and
fewer co-payments to lower monthly contributions and more co-payments.
"This may explain part of the preference for more
comprehensive and expensive options."
However, despite dissatisfaction few members change schemes.
"Of the members surveyed, 91% had not changed scheme or
scheme options in the last three years - however, when comparing the price and
their benefits of their old versus the new options, it emerged that members
favour better value rather than lower cost," Hulme said.