CMS State of Medical Schemes 2023

 

Summary of the key statistics from the CMS Industry Report 2023, making it easier for the layperson to understand:

1. Number of Medical Schemes: The total number of medical schemes in South Africa has decreased to 72, continuing a downward trend.
2. Beneficiaries: While the number of medical schemes is declining, the total number of people covered (beneficiaries) has actually increased. However, the percentage of the population that these beneficiaries represent has dropped from 16% in 2000 to 14.7% in 2023.
3. Average Age: The average age of people in medical schemes is 34 years. Women in these schemes are slightly older, averaging 35.2 years.
4. Pensioners: The proportion of pensioners (older adults) in medical schemes has increased slightly, from 9.3% to 9.4%.
5. Healthcare Spending: Total spending on healthcare benefits rose significantly, reaching over R200 billion in 2023, which is an increase from the previous year.
6. Claims per Person: On average, each beneficiary had 8.2% more claims paid for their healthcare compared to the previous year.
7. Medical Savings Accounts: The amount of money used from medical savings accounts for healthcare benefits increased to R2,547.17 per person.
8. Risk vs. Savings Benefits: Most of the money spent on healthcare (90%) goes towards risk benefits (like hospital stays and surgeries), while only 10% is used from savings accounts.
9. Hospital Costs: Hospital expenses make up a significant portion (39.22%) of the total risk benefits paid.
10. Out-of-Pocket Payments: People are still paying a lot out of their own pockets for healthcare, especially for medicines, which accounted for a large part of these costs. This percentage increased from 26.83% in 2022 to 27.59% in 2023.
11. Chronic Conditions: The most common chronic health issues among beneficiaries are high blood pressure, high cholesterol, and type 2 diabetes. Spending on these conditions has also gone up.
12. Geographical Distribution: Gauteng province has the highest number of beneficiaries, making up nearly 40% of the total, while the Western Cape and KwaZulu-Natal follow with smaller shares.
13. Scheme Options: Open medical schemes offer three times more benefit options compared to restricted schemes, providing more choices for members.

This summary presents the statistics in a straightforward manner, making it easier to grasp the current state of the medical schemes industry in South Africa.