Courtesy of Elsabe Klinck and Associates
The CMS Annual Report, covering the 2021 medical schemes year has been released. Contrary to expectations, scheme membership has increased by 0.5% to 8.94m in 2021. Medical scheme membership as a percentage of the population has, however, decreased since 2000. The average age of a beneficiary is 33.6 years, with, as expected, a significant increase in costs as members age.

Industry solvency stands at 46.73% – close to double the required level of 25%. Discovery, Medscheme and Metropolitan continued to dominate the administrator market, making up 83% of that market. Total healthcare expenditure was R205.3bn. This comprised of 35.7% private hospital spend, 26.1% specialists, 16.1% medicines dispensed, 7.9% supplementary HCPs and 5.1% GPs. The average cost to provide the full PMB package of 270 DTPs and 25 CDLs, is at R1 000.

Out-of-pocket (OOP) expenditure increased significantly over the past five years and significantly more for open- than restricted schemes. As was the case in 2020, medicines in 2021 made up the bulk of such payments by members (35.47%), followed by specialists (25.92%) and supplementary HCPs (14.65%). The report also contains information on the utilisation of technology (dialysis, CT scans, angiograms, etc.), as well as information on disease programmes, such as HIV.

Elsabe Klinck and Associates CMS Industry Report summary report is available at R2 100 + VAT. Contact Eugenia.