The Council for Medical Schemes (CMS) has published its preliminary industry report, outlining the state of the medical schemes industry and some of the emerging trends in South Africa.

According to the group, the years-long trend of consolidation has continued in the country, with the number of medical schemes declining from 144 in 2000, to just 72 in 2022.

The highest period of consolidation occurred between 2007 and 2010, where numbers were whittled down to just 100 schemes, but the trend has continued since then. Three more schemes were consolidated between 2021 and 2022.

At the same time, the number of medical aid beneficiaries has continued to rise.

In 2022, there were over 9 million lives attached to medical schemes in South Africa, with increases seen in both closed and open schemes.

However, the increases were not proportionate to overall population growth, the CMS said, noting that population coverage declined to 15% in 2022 from 16% in 2000.

The growth in medical scheme memberships were also not the same across the different schemes – notably, large medical schemes grew their memberships while medium and small schemes saw numbers decline.

“A remarkable trend emerged, with seven schemes exhibiting significant expansion, recording growth rates of 5% or more,” the CMS said. These schemes were Bestmed, Thebemed, Medihelp, Umvuzo, Platinum Health, Retail Medical Scheme and government scheme GEMS.

Conversely, other schemes saw substantial declines of between 5% and 10%.

Payouts

According to the CMS, across all schemes, total benefits paid in 2022 amounted to R224.1 billion – up 9.2% from the R205.3 billion recorded in 2021.

Risk benefits made up the bulk of the payouts, at R203.3 billion, with savings at R20.8 billion, comprising only 9.3% of total benefits paid.

The average claims paid per beneficiary amounted to R23,878 – up 3.5% from the R23,060 recorded in 2021.

The average amount spent from medical savings accounts was at R2,327, the CMS noted.

According to the CMS, the “exceptionally high” claims ratio observed in the data over the past year is due to the surge in demand for postponed procedures following the Covid-19 pandemic.

Looking at longer trend data, the CMS said that benefit payouts have increased by 17.3% since 2015, though restricted schemes have shown a bigger payout trend, up 22.5% versus the 13.7% from open schemes.

The CMS noted that closed schemes have also tended towards more comprehensive coverage plans for their members, while open schemes have ventured into more variety in their offerings.