Medical aid price warning in South Africa as new trend emerges

GTC Healthcare Consulting warns that deferred medical scheme contribution increases in South Africa are likely to be followed by above-inflation hikes in January 2023.

The financial advisory business, specialising in retirement fund administration, noted a recent wave of deferred medical scheme contribution price increases and anticipates further increases in excess of inflation in 2023.

Traditionally, medical aid schemes implement fee increases from 1 January every year. However, the last two years have seen new trends emerge because of the Covid-19 pandemic.

These include deferral of increases, dipping into reserves to reduce increases and announcing delayed increases above CPI, noted Lee Callakoppen, principal officer of Bonitas Medical Fund.

The reduction in claims experienced during the Covid-19 pandemic, alongside a desire to maintain affordability for members in a low-inflation environment, saw many schemes defer their 2022 increases, with the biggest open medical scheme – Discovery – originally deferring its increase from January to May 2022, and then again until October.

While the January 2023 increases have not yet been announced,Discovery has confirmed a 7.9% increase in October 2022, which will carry through to December. Various other schemes increased their contributions earlier in the year, although many were also deferred beyond January.

The October 2022 increases will almost certainly be followed by scheduled increases in January 2023, said GTC. “Interim increases are administratively expensive and disruptive, and we suspect schemes will return to the traditional January increase date from next year,” said Jill Larkan, head: healthcare consulting at GTC.

In a Circular published in July (Circular 44 of 2022: Guidance on benefit changes and contribution increases for 2023), the Council for Medical Schemes (CMS) recommended that contribution increases for the 2023 benefit year should not exceed 5.7%, “in line with the 2023 consumer price inflation (CPI) forecast of the South African Reserve Bank,” but that “due to unique industry-specific cost-push factors … some schemes may require contribution increases above inflation.”

“In previous years, medical schemes have typically exceeded the CMS increase guidelines by around 4%, as is evidenced by the information provided by the CMS in their circular,” said Larkan.

On that basis, taking into account the anticipated ‘return to normal’ happening within medical aid claiming patterns being reported by the schemes at the moment, GTC anticipates that the 2023 increase will be in the range of CPI (5.7% forecast by the SARB in their July Monetary Policy Statement) plus 4% (general average increase above inflation provided by the CMS), resulting in an average increase of between 8% and 10% per annum in January 2023 – if nothing else dramatic changes.

The CMS circular itself notes that “… medical scheme contribution increase rates have consistently surpassed the CPI, except in 2021 … [which was] the first time in over a decade that the industry implemented contributions increase below CPI.”

“The lower-than-anticipated increases in 2021 were due to the financial constraints that South African consumers are facing on the one hand, and underutilisation of the medical aid benefits resulting in record reserves held by the medical schemes on the other,” said Larkan.

Lower-than-usual usage of medical scheme benefits among members who were fearful of doctor visits and hospitalisation in the context of the Covid-19 pandemic resulted in combined medical scheme reserves growing to a record R73.29 billion in 2021.

“If schemes do not, at the very least, keep their increases in line with medical inflation year-on-year, acknowledging that this medical inflation has always outstripped CPI, there will come a time when their members must endure a sudden once-off adjustment to ensure that contribution rates match the anticipated medical inflation increase rates year-on-year,” said Larkan.

“And in our current economic climate, no member wants to endure that kind of ‘catch-up’ pain after a ‘budget-friendly’ financially abundant period of deferred or non-existent annual increases.”

Larkan advises all members that the relief on personal budgets – granted by the deferment of increases until October 2022 – is fast drawing to an end. These October increases as well as the anticipated return-to-normal January adjustments, just four months later, will result in the further tightening of the budget purse strings for many families.

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