Age more than just a number for medical aids

2012-09-08 14:50

South African medical aid members are living longer and, as they get older, poor health means they are claiming more and more from their schemes.

Last year, medical schemes paid R93.2 billion in medical claims and 36.6% or R34.1 billion of that money was paid to private hospitals.

According to the Council of Medical Schemes’s latest annual report, spending on private hospitals increased by 9.7% last year because more members were admitted to hospitals and spent longer in wards than they did in 2010.

Senior manager and researcher at the Council for Medical Schemes, Michael Willie, attributed the increase in private hospital expenditure to schemes’ ageing membership.

The average length of a stay in private hospitals for 2011 was 3.2 days, a slight increase from three days in 2010.

But, when the length of stay was broken down into ages, an entirely new picture emerged, Willie said.

“When broken down according to age bands, you would realise that on average old people stayed in private hospital for about six days, which is double the average.

“What this tells us is that medical scheme members are ageing and as they get older the burden of diseases increases and they require treatment for longer in hospitals.”

There were more than 560 000 people above the age of 65 registered with medical schemes last year.

Most of them were registered with open schemes, like Discovery Health.

Chief executive officer of Discovery Health, Dr Jonathan Broomberg, confirmed the findings of the CMS report.

Broomberg told City Press: “Scheme members are getting older and sicker.”

“Chronic disease levels are much higher amongst older ages. By the age of 65, more than 60% of members suffer from chronic disease, and by ages 75 to 80, 80% of all members suffer from chronic disease,” Broomberg explained.

Willie cautioned schemes against the ageing profile, saying it came with a great deal of risk.

“Age profile has an impact in the sustainability of the schemes,” he said.

Willie’s view is supported by the findings of another recently released research conducted by Stellenbosch consultancy Econex.

The Econex report also found that as members get older and sicker they drive up the cost of private healthcare.

Willie said that while the chunk of medical claims came from private hospitals, it should noted that medical specialists and medicines dispensed by pharmacists also contributed to the rising private healthcare expenditure.

He said: “Specialists were paid R21.3 billion last year, which was an increase of 13.5% when compared to 2010.

“This clearly shows that people are jumping general practitioners and going straight to specialists.

“Although claims from general practitioners increased by 9.7% in the past two years, the average number of visits to a GP per beneficiary remained the same for the same period,” he explained.

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