I am not easily enamoured with medical aid schemes.
Sadly, South Africa’s public healthcare system has failed all of us. The majority of South Africans can never afford the enormous subscriptions for private medical aid which, along with the co-payments for “ifs and buts and maybes”, means being stuck in long queues at poorly staffed and mostly crumbling State hospitals. The rest of us eke out cover (balancing the best benefits against the lowest monthly cost) courtesy of one or another scheme which our employer has bought into.
Our medical professionals seem to trade in a service-to-the-people orientation in favour of chasing a crass materialistic ethic the moment they make it through their stint in a community hospital.
Despite government intervention 10 years ago, pharmaceutical and technology companies enjoy vast profits.
And, where the heck is that national health scheme?
All these factors play into the need for an effective, well-regulated medical aid system.
Despite being not-for-profit entities, there are huge financial rewards for directors (trustees) and managers (officers) of South African medical aid schemes at the expense of a caring, individually-focused emergency insurance system for consumers.
So, the numbers in a latest report from Discovery Health are impressive to the point of being overwhelming. But they also raise many questions about the nature of our society – not least about how we valorize these intermediaries who cream it off seemingly with great relish.
R26-billion of Discovery Health’s total medical aid claims of R50-bn in 2017 went towards hospital admissions. In a report released today, Discovery’s Jonathan Broomberg notes that it covered just over 670 000 hospital admissions. “The highest claim covered by the scheme was R6.8 million towards 199 days of treatment for a 58-year old for a cardio-vascular related condition. This single claim would require 205 years’ worth of contributions by the member to cover the claim”.