Anger at higher premiums and fewer benefits

Discovery Health, targeted in online petition, defends its approach to achieving the 'right balance', writes ADELE SHEVEL

A groundswell of frustration is mounting against medical aids after another round of reduction in benefits.

Medical aid benefits are traditionally cut each year to counter rising costs, and they come hand in hand with an increase in premiums.

Medical aid members, irate over rising premiums and declining benefits, have been slow to take up the fight, but have recently taken to social media to voice their discontent.

An online petition set up just over 10 days ago has gathered more than 700 signatories to pressure Discovery Health to alter limits set for services such as physiotherapists, occupational therapists and psychologists.

Dentists, radiologists and doctors have come out against lower benefits.

The South African Dental Association has warned that, during the past few years, once thriving dental practices have been going bankrupt and dentists are emigrating.

Maretha Smit, CEO of the association, said payouts to dentistry from medical aids have been reduced from 8.4% in the late '90s to 2.2% last year. She said benefits needed to be restructured.

The Radiological Society of South Africa, representing more than 600 professionals, said the manner in which the country's largest medical schemes are levying co-payments on their members was of great concern. It said in a statement a number of medical schemes were contravening the Medical Schemes Act by requiring patients to self-fund the cost of scans despite co-payment exemption for prescribed minimum-benefit conditions.

"It is appalling that benefits are getting progressively eroded by medical schemes," said Norman Mabasa, chairman of the South African Medical Association. "What is amazing is that, while these benefits are being eroded, payments of hospitals and administrators don't change and continue to rake in profits."

He said medical aids were covering incidents that were more unlikely to happen, while benefits for daily occurrences such as flu, ear infections and eye infections were low.

"If one member is admitted to hospital for three weeks, when that member comes out, the whole family has run out of medical benefits for the year. The benefit design of schemes is not in favour of the patient."

He said the Medical Schemes Act should be revised.

Jonathan Broomberg, CEO of Discovery Health, said one of the main challenges wasachieving the right balance between providing excellent, clinically appropriate healthcare benefits while at the same time keeping contributions affordable for members on a sustainable basis.

"Finding this balance is increasingly difficult, as healthcare costs increase above CPI owing to ageing populations, more chronic diseases and cancer, as well as costly new treatments and drugs."

He said some of the statements released by specific interest groups were misleading and did not accurately reflect the facts regarding the benefits offered by Discovery Health or the payments made to specific groups of healthcare professionals. "Discovery's approach has always been to provide unlimited and comprehensive benefits when members have the greatest need."

Tembinkosi Bonakele, deputy commissioner of the Competition Commission, said the commission was still considering a n investigation into healthcare costs .

"The issue of costs in private healthcare has come up from various stakeholders. It is something that concerns us and there seem to be limited tools to address it."