Medical schemes regulator hopes to finalise low-cost medical aid laws in 2023

[Supervan II]

Thing is, this is the free market that everyone wants. We can't have it both ways.

A good doctor with a good track record can name their price and they know it. Regulating doctors in order to regulate medical aids will just chase much needed skill overseas. We'll be left with cheap doctors to match our cheap rates. Which is a worse problem to have...

This is exactly what will happen when NHI is implemented

 

[Kosmik]

Basic hospital plan on Discovery is now almost R4000 for a couple. Insane.

Go smart.

 

[RedViking]

Go smart.

R4000 a month for a couple

 

[surface]

R4000 a month for a couple

I wouldn't mind this if doctors didn't charge so much above rates. My son's Paediatrician charges 1500 rands for 30 minute consultation and discovery reimburses only R800 or so.

 

[Kosmik]

R4000 a month for a couple

yeah but its more than the basic hospital only.

 

[RedViking]

yeah but its more than the basic hospital only.

I noticed that. Will see what is covered in my area.

 

[koeks525]

Medical care is just one of those matters which will always remain confusing. Once cheaper options are on the market, people will complain about the limited cover such options provide.

I think having a decent medical aid plan, as well as decent savings in the bank to settle any shortfalls is the winning solution. Presently, I am on Discovery's Essential Saver Plan (contemplating an upgrade next year). Sadly, I was in and out of specialists this year, which ran my MSA to the ground rapidly. I've had to settle almost R8K (so far) with my emergency savings as the MSA ran dry, hehehe.

What I always find interesting is people who complain about how pricey medical aid is, but are the same people who earn good salaries, drive around a good car, spend a lot of money on other things (flights, entertainment, etc. ), but have little to no savings or investments.

 

[RiaX]

In case you wondering. Drs increase their fees to limit the crowd in their practice.

It's easier and cheaper for them to do that than to hire more drs and expand the practice.

 

[OhYeah84]

The time has come for SA then where every citizen should learn medicine so you can tell the doctor what to prescribe. As for technical operations, plan ahead and plan a trip abroad, else pass away in some State hospital. Our options are getting limited already.

What...in the nation of 30%-ers? Are you applying logic here, or some whimsical idea.

Please show us 1 country where this has been done, and I'll listen to the crickets in the meantime while waiting.

 

[koeks525]

In case you wondering. Drs increase their fees to limit the crowd in their practice.

It's easier and cheaper for them to do that than to hire more drs and expand the practice.

Not sure if this is always true. I think most specialists would run things according to their schedule and availability. At least with the specialists I been to, you have to make an appointment upfront. It is rare being able to walk into one without an appointment. Some would be fully booked for months even.

 

[die_koos]

Medical aid has become just like insurance, they have a team of actuaries who figure out exactly how much to charge so that they remain profitable. Then they hide the details behind different cover levels and scheme types to make it almost impossible to compare two different schemes or products within the same scheme.

So most people end up rolling the dice and hoping that the plan they chose will cover them for whatever happens to them...

For example - the medical aid can figure out that the actual chance of getting a heart attack is low across their client base , so they provide "full comprehensive cover for cardiac events" and punt it as a feature, meanwhile they know the chances of getting cancer is high, so they cover oncology up to R 500 000 per member, which sounds great on paper but runs out very quickly if you need to get chemo etc.

The average person has almost no way of figuring out their own risks to the level that the medical aid has so the game is rigged in favor of the scheme.

 

[PaulMurkin]

Well a good start, my medical aid (Expensive waste) refused to pay for a new operation on current plan already expensive, so I moved up a plan at double the payments, guess what, after doing my sums, I realised I payed that year for the operation in full out of my pocket, they dont even pay out chronic medicine fully, I am a 100% profit to them. Before them, before 1992 the medical aid just work, was cheap and affordable, and an operation got done no questions asked, then came digital era, and the easiness of adding Rules & Plans on the fly, just F-Upped the whole complete scene for good.
So its time to look at this mal practices.

What happened was in 1994 Adrian Gore and his cronies came with their schitt from the United States...
Enter Disrobbery Health.

Then the government came with their crap.

And now you have the crappy situation that exists in SA.

 

[hellfire]

Basic hospital plan on Discovery is now almost R4000 for a couple. Insane.

That's the major insurance cost that needs to be covered.
Day-to-day cover is generally just pre-funding your own spend anyway.

 

[hellfire]

What happened was in 1994 Adrian Gore and his cronies came with their schitt from the United States...
Enter Disrobbery Health.

Then the government came with their crap.

And now you have the crappy situation that exists in SA.

That's some heavy revisionist history.
Gore conceptualised and implemented his ideas here, and then took them to the USA

 

[Forum Reader]

The medical aid 100% is a BS figure that they dreamed up and is totally out dated

Want to know why a MRI scan costs how much it costs ?

Well the machine is 10 to 15 million rand. The room requires specialized work to seal it , the electrical costs are ENORMOUS and it's coolant is 300k per month. Medical practices are a business they need to turn a profit. They are highly skilled so they deserve to be well paid for such services. It makes me sad people will pay ludicrous amounts of money for luxuries but not for their health.

I know for a fact that the medical aid rate of 100% for a MRI was below cost at one point.

Yes doctors are expensive and certain fields can be cheaper but not that cheap. Instead of blaming the practioner perhaps we should ask why the insurer (which is what medical aid is) is only paying one third of the claim.

We being conned they say 100% rate but in reality it's 33%

FYI they regulated pharmacy around 08/09 and they collapsed the industry for many people. Medicine cannot fall as well then our health system will collapse.

It's because if the scheme pays 3 times more then your premium will be 3 times higher which will be unaffordable for most. It's a balance of the size of the premium vs the payout.

Medical aid is just insurance. The money doesn't appear out of nowhere. It comes from the premiums that people pay. If someone claims R5m and pays R100k in premiums, 49 other people need to pay R100k and claim nothing for the scheme to just stay afloat.

 

[RiaX]

It's because if the scheme pays 3 times more then your premium will be 3 times higher which will be unaffordable for most. It's a balance of the size of the premium vs the payout.

Medical aid is just insurance. The money doesn't appear out of nowhere. It comes from the premiums that people pay. If someone claims R5m and pays R100k in premiums, 49 other people need to pay R100k and claim nothing for the scheme to just stay afloat.

Yes I understand that but then dont call it 100% when you not paying 100%

 

[RedViking]

yeah but its more than the basic hospital only.

Ah remember now. Hospitals in my area is not covered. And when I lived in stinky Town the hospital I wanted to use was not covered, only the one I did not want to use.

 

[Moto Guzzi]

It's because if the scheme pays 3 times more then your premium will be 3 times higher which will be unaffordable for most. It's a balance of the size of the premium vs the payout.

Medical aid is just insurance. The money doesn't appear out of nowhere. It comes from the premiums that people pay. If someone claims R5m and pays R100k in premiums, 49 other people need to pay R100k and claim nothing for the scheme to just stay afloat.

Yes thats how its suppose to work, otherwise if most people are sick all the time, you will not see a medical aid in excistance, also for insurance, the concept is based on most will be ok most of the time.