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HEALTH: New GTC Survey Simplifies Medical Aid Choice, Successfully Ranks and Rates All Open Schemes and Plans


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Selecting a medical aid that meets one’s needs is an exercise fraught with anxiety and frustration. Whilst this decision is often left to corporate HR departments that work with consultants to guide them on the best options, individual members seldom have certainty they are on a plan that best suits their needs.

Brokers and consultants also similarly rely on their past choices rather than empirical data.

With the release today of the 2016 GTC Medical Aid Survey, however, this decision-making process has been simplified to give members, brokers and consultants unprecedented clarity and ease of use in choosing the most appropriate medical aid scheme and plan, for any person, family or organisation.

Based on data provided in the latest Council for Medical Schemes (CMS) annual report as well as on annual data from each medical aid scheme and plan provider, GTC has applied its own measures to produce a ranking and measurement system that sheds new light on the affordability, applicability and viability of the vast range of available schemes and plans.

The 2016 survey by GTC Healthcare Consulting is the sixth annual research survey in the series, and provides analysis and ranking of different medical aid plans, according to the various options offered and available by South Africa’s 23 open medical aid providers (Profmed is the only “closed scheme” included in GTC’s survey, along with seven non-hospital providers).

“The data from the CMS is publicly available, so while any scheme member, consultant or broker is able to access this information, the information is hardly ever used to help inform decisions on the most applicable options,” says Jill Larkan, Head of Healthcare Consulting at GTC. “With this latest survey we have made the bold attempt to extrapolate the relevant content from the CMS’ data whilst overlaying our unique insights and intelligence to produce a clearer view of the best options.”

In order to increase access, GTC will be launching the first online portal at the end of June 2016 which will offer ease of use by allowing anyone to make informed comparisons between the different medical aid plans.

Larkan says that making the right choice is complicated by the vast amount of information one has to consume, the assumptions that have to be made, overlaid by how information provided by the CMS might influence the wellbeing of scheme members and their families in the long term.

The rating system developed by GTC delves beyond traditional measures such as the monthly premium and benefits offered by different plans to analyse the underlying factors that impact a scheme’s financial wellbeing.

Larkan says that data such as the number of members, their average age and scheme solvency ratios may appear to give a fair indication of a scheme’s viability, but these measures fail to give an accurate picture unless viewed in conjunction with premium and benefit comparisons.

“Medical schemes with a solvency ratio that is consistently above 100% over many years, for example, may appear to indicate a healthy scheme. But if that same scheme is experiencing falling member numbers, that high solvency ratio could merely be a reflection of a declining membership base, because members who leave the scheme do not take their reserves with them when they exit,” she explains.

“Applying our rating system to this data then would result in such a scheme scoring very low because of factors that could materially impact the scheme’s ability to cover members’ claims in the long run,” says Larkan.

Larkan says that Topmed and Compcare scored really well in the Principal membership rankings, and Bonitas and Genesis were tops in the Pensioner ratio ratings.

“There were no exceptional performers in either the ‘Solvency’ or ‘Average Age’ calculations, with multiple good performers reflected in both of these categories,” she continues.

Overall medical scheme ratings aside, GTC has also analysed, grouped and ranked the different plans available, across different family sizes.

Making the right decision could make a significant difference in a member and his/her family’s ability to access the right level of medical care, without the monthly premiums causing undue strain on the monthly budget. Matching the desired, with the required, level of cover and making sure that this fits within the family’s budget, whilst ensuring that the scheme is around for many years to come is simplified somewhat by the availability of this survey.

The full range of plans - from entry-level, hospital only, comprehensive, to network and non-network plans - have been graded and categorised to simplify the choice and provide an easy way to compare options and cost.

“This, rightly, makes up the bulk of the report as this is what the majority of members, brokers and consultants are most concerned with. These tables provide detailed scoring and cost analysis, which is then simplified by our ‘likelihood of support’ rating of high, medium, or low,” says Larkan. “This rating indicates the likelihood of us recommending a particular plan given the schemes’ demographics, cost and rating which we have developed.”

GTC Macro Rankings for 2016 according to analysis of the CMS’ Report

Top quartile performers in the macro rankings for 2016, which are those schemes that are ranked in the top 25% according to GTC’s full analysis of the CMS’ Report are (in order of rankings) 1st Compcare, 2nd Bonitas, 3rd BestMed, and 4th Genesis/Momentum (sharing 4th place).

“Compcare, Bonitas and Genesis were good performers in the sectors mentioned earlier according to our GTC rankings of the CMS report and we believe that BestMed performed consistently throughout all the categories in the GTC survey, resulting in their third place ranking according to our Macro analysis,” continues Larkan. “Discovery, the biggest Open Medical Scheme in South Africa, placed 7th in our 2016 macro rankings.”

GTC’s overall list of schemes for 2016 – ranked by “likelihood of support”

Larkan believes that the overlay of the macro rankings on the micro premium extrapolations form a solid guide towards decision making, while simultaneously easing the consultants’ ongoing investigatory burden.

The macro and micro rankings combine to create GTC’s overall list of schemes in the Medical Aid Survey for 2016 ranked by “likelihood of support”. The final analysis reflects a score which indicates the likelihood that a particular plan / scheme would receive GTC’s support or not through recommendations to clients.

As Larkan says, “This list reflects the overall best scoring plans in our comparisons across all sectors.
This is by no means a definitive or final rating, as ‘soft’ factors such as existing servicing relationships, past experience, administration ability, SLA’s and turnaround times and / or call centre availability have not been taken into account,” cautions Larkan.

“No medical plan is going to suit all members equally, but at least an informed decision can be made based on these indicators, which will go a long way to easing member concerns about what is best for their needs,” Larkan concludes

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