South Africa’s private healthcare sector is experiencing rising treatment costs for medical aid members, driven by specialist shortages, questionable billing practices, and a lack of pricing regulations. Martin Rimmer of Sirago noted that while treatment types have not changed, the costs have increased, resulting in larger shortfalls for gap claims not covered by medical schemes.
In South Africa, the rapid increase in the costs of treating members of medical aid plans is creating significant challenges for the private healthcare sector. Key factors contributing to this issue include a shortage of medical specialists, questionable billing practices by certain healthcare providers, and the absence of pricing regulations for healthcare specialists. As a result, medical aid members are experiencing increased financial burdens.
Martin Rimmer, CEO of Sirago Underwriting Managers, highlighted that although the types of treatments leading to gap claims—such as those for cancer, circulatory, and musculoskeletal conditions—have remained stable, the costs associated with these treatments have significantly risen over the last five years. This discrepancy has resulted in growing shortfalls that medical schemes do not cover.
To illustrate this trend, Sirago presented data on its 20 largest gap cover claims anticipated for 2024. The insurer indicated that gap insurance is designed to address the difference between the charges set by healthcare specialists for in-hospital procedures and the amounts paid by medical schemes, irrespective of whether those specialists have entered into tariff agreements with the schemes.
The South African private healthcare sector faces increasing costs for treating medical aid members, primarily due to a shortage of specialists and problematic billing practices. As treatment costs have risen markedly in recent years, gap claims have become more prevalent, exposing significant financial shortfalls not covered by medical schemes. This situation underscores the urgent need for regulatory reforms to address these disparities.
Original Source: citywire.com
