The best and worst medical aid schemes in SA

Medical schemes
Medical schemes

With private healthcare becoming a grudge purchase, medical aid policyholders are increasingly expecting value for money from their schemes.

Liberty overtakes Bonitas

However, while some companies were given a clean bill of health in the South African Customer Satisfaction Index (SAcsi), others are in need of urgent care.

The survey asked a sample of 2 105 private medical aid policyholders to rate their schemes.

Participants gave the health insurance industry a satisfaction score of 74.2 out of 100, with Liberty overtaking Bonitas to lead the market.

Read: Why choosing cheaper medical cover can cost you in the long run

The six companies included in the survey were Bonitas, Discovery Health, Liberty Health, Medihelp, GEMS and Momentum Health based on their market share.

The results revealed that Liberty scored an industry-leading 76.9 out of 100. Momentum Health (75.6), Bonitas (75.2) and Discovery Health (74.1) ranked on par with industry. Medihelp came in below par at 70.7 and GEMS limping behind with a score of 67.5.

SAcsi looked at satisfaction with the three types of medical plans: comprehensive, network schemes and hospital plans.

Higher scores than US

People with comprehensive plans were more satisfied (76.1) than those on hospital plans (72.2) or network options (70.3). Participants who experienced rejected claims reported dramatically lower overall satisfaction levels of 63.3.

Read: How to make your savings account stretch

While Liberty and Momentum Health are the only two brands that showed an increased value in the year-on-year comparison since 2014, GEMS recorded a seven point decline in its score.

The South African healthcare insurers obtained significantly higher overall scores than the US.

“While GEMS is performing at the lower end of the scale, the other South African healthcare providers compare favourably with their counterparts in the US and Singapore,” the study found.

Prof Adré Schreuder, CEO of Consulta and founder of SAcsi, explained to Health24 what metrics the SAcsi medical survey use to determine the medical aid industry leader.

"The model combines three drivers of customer satisfaction: customer expectations, perceived quality and perceived value. The calculated customer satisfaction index is statistically linked to two outcomes: customer complaints and customer loyalty."

Advice for companies

He said it is clear that South African medical aids are working to reduce the number of complaints and improve how they are handled, as evidenced by significantly fewer complaints.

“Liberty has reported less than half the number of complaints since last year, reducing this from 23% of customers to 10.4% of customers. In addition, they improved how complaints are handled. Momentum has the highest score in the industry when it comes to handling complaints satisfactorily.”

Read: Medical scheme dependants: who qualifies?

Prof Schreuder also offered some advice for companies.

"Any customer complaints relating to the key drivers [customer expectations, perceived quality and perceived value] should be carefully analysed and better understood in order to determine the root causes and put corrective processes in place to improve."

He suggested that many companies do not understand the actual journey of their customers in dealing with them and that going through a process of customer journey mapping can provide valuable insight into precisely what the key drivers are.

"This will help them keep their finger on the pulse and help them to ensure that potential pain-points are navigated with the least amount of inconvenience for customers."

Also read:

What to look out for when choosing a medical scheme

SA medical service providers are overcharging

25 chronic conditions your scheme must cover

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