Healthcare consulting and advisory firm Simeka Health has flagged an increasing number of employers not forcing their staff members to become part of medical schemes, leading to a shrinkage in compulsory participation.
- This trend comes at a time when the industry is already grappling with a stagnant market, with only 8.9 million South Africans having medical aid, despite population growth, according to the Council for Medical Schemes.
- Simeka Health’s MD, Mbali Khumalo, warns that fewer young and healthy people joining medical schemes means that the cross-subsidisation for the old and sickly is dwindling, with the industry worrying that this shrinking pool of the addressable medical scheme market will worsen under the National Health Insurance (NHI).
- The NHI is a legal instrument that will introduce universal healthcare financing in South Africa, but some industry players who submitted written public comments have raised concerns that the funding model is unclear and may lead to underfunding.
- While more women join medical schemes when they are about to have children and know they will require hospitalisation, Simeka Health’s analysis of different medical schemes’ data shows concerning trends of increasing diagnoses relating to mental health, behavioural risks, and life-threatening conditions.
- As more employers relax their compulsory medical scheme membership rules, they are not even replacing them with corporate wellness solutions, like on-site clinics, primary health insurance, or employee assistance programmes.