South Africa’s private healthcare sector is facing rising costs for medical aid services due to shortages of specialists, questionable billing practices, and lack of pricing regulation. These factors have led to increased gap claims, particularly in areas such as cancer and musculoskeletal treatments, burdening patients financially.
The private healthcare sector in South Africa is currently experiencing significant cost increases for treating medical aid members. This is largely due to a shortage of medical specialists, questionable billing practices by healthcare providers, and the absence of pricing regulations for these specialists. Consequently, patients are facing greater financial burdens.
Martin Rimmer, CEO of Sirago Underwriting Managers, highlighted that, although the types of treatment prompting gap claims—such as cancer, circulatory, and musculoskeletal issues—have not changed, the costs associated with these treatments have escalated over the past five years. This has led to growing shortfalls that are not covered by medical schemes.
To illustrate the impact of these rising costs, Sirago Underwriting Managers reviewed its twenty largest gap cover claims for 2024. Gap insurance is designed to cover the difference between the fees charged by healthcare specialists for in-hospital procedures and the amounts covered by medical schemes, regardless of the provider’s tariff agreements with the scheme.
In summary, the surge in medical aid shortfalls in South Africa’s private healthcare sector can be attributed to a lack of medical specialists, problematic billing practices, and insufficient pricing regulations. These factors have resulted in increased treatment costs and significant financial shortfalls for patients, necessitating the use of gap insurance to cover the difference between charges and medical scheme payments.
Original Source: citywire.com
