Medical fund members paid R32.9 billion out of their own pocket last year for medical services. In addition, this amount increased from R31.9 billion in 2017 and is almost R9 billion more than the R24 billion paid by members in 2014 itself.
This is how the Medical Aid Board’s annual report for the 2018/19 financial year, released on Friday. This amount was calculated by deducting the amount claimed by members for treatment or medication from the amount eventually paid out. “The actual expenses incurred by members are likely to be much more, as not all medical treatment is required,” the report states.
Medical aid members spend most of their own money on medication (33%), GPs (9.7%) and medical and surgical specialists (7.5%).
The largest percentage of money in patients’ medical savings accounts is also spent on medication and GPs. “The high amount that members pay to surgical specialists is probably because these specialists’ rates are, on average, higher than the scheme’s tariff rate,” the report states.
Medical funds paid out a total of R173.3 billion in member benefits in 2018, an increase of 8% of the R160 billion paid out in 2017. Medical aid funds paid an average of R19 500 per beneficiary per year. Most of the money (37%) was paid out for hospital services, followed by money for the medication (15%).
Complaints against medical aid due to default also increased during the past financial year.
According to the report, there was an increase in complaints from medical practitioners in the previous financial year because in some cases medical schemes decided not to pay claims for treatment. In most cases, the medical aid concerned requested additional information regarding doctors’ working hours, location of their practice and the time spent on a particular patient. However, some doctors refused to answer these questions based on physician-patient confidentiality, the report said.