The South African private healthcare sector faces increased costs for medical aid members due to a scarcity of specialists, dubious billing practices, and lack of regulatory pricing. Treatments for conditions like cancer and musculoskeletal issues remain the same, but costs have risen significantly, leading to greater financial shortfalls.
In South Africa, the private healthcare sector is experiencing significant increases in the costs associated with treating medical aid members. This surge is largely attributable to a shortage of medical specialists, questionable billing practices by certain healthcare providers, and the absence of pricing regulations for healthcare specialists. As a result, members of medical aid schemes are feeling financial strain.
Martin Rimmer, CEO of Sirago Underwriting Managers, noted that while the categories of claims remain unchanged—including cancer, circulatory, and musculoskeletal conditions—the treatment costs for these conditions have risen dramatically over the past five years. This increase has exacerbated the issue of shortfalls, which are not covered by medical schemes.
To highlight this issue, Sirago has provided examples of its largest gap cover claims for 2024. Gap insurance is designed to cover the differences between the charges imposed by healthcare specialists for in-hospital procedures and the payments made by medical schemes, regardless of whether or not the provider has an agreement with the scheme.
The rising costs in South Africa’s private healthcare sector, influenced by a shortage of specialists and inadequate pricing regulations, are severely impacting medical aid members. The consistent drivers for gap claims, including serious health conditions, require a focused approach to mitigate financial burdens on patients. Insurers like Sirago illustrate the necessity of gap insurance in addressing the shortfalls not covered by medical schemes.
Original Source: citywire.com
