Quarterly medical scheme review

Transcription

1 Quarterly medical scheme review 2014 Quarter 1 The purpose of the quarterly medical scheme review is to give readers an overview of the performance of medical schemes which have been administered by Discovery Health over the most recent quarter. It provides details on key demographics, claims and financial performance metrics, with specific focus on the Discovery Health Medical Scheme (DHMS).

2 1.1 An overview of schemes administered by Discovery Health Discovery Health administers the largest open medical scheme in South Africa, as well as 13 restricted medical schemes, these are referred to as InHouse medical schemes. Health lives administered by Discovery Health at 31 March 2014 Number of health Number of health lives Total administered by Discovery Health 1,336,680 2,861,013 Discovery Health Medical Scheme (DHMS) 1,195,094 2,569,679 InHouse medical schemes 141, ,334 The graph below reflects the number of health lives under administration as at year-end (or at 31 March 2014 for this report, if not at year-end). Page 1

3 Schemes administered at 31 March 2014 Number of health health Number of health lives health lives Discovery Health Medical Scheme 1,195, % 2,569, % Tsogo Sun Group Medical Scheme 4, % 9, % Anglovaal Group Medical Scheme 3, % 7, % Retail Medical Scheme 9, % 17, % Quantum Medical Aid Society 5, % 12, % LA Health 50, % 119, % Lonmin Medical Scheme 21, % 23, % MMED Option of the Naspers Medical Fund 3, % 7, % UKZN Medical Scheme 3, % 7, % Remedi Medical Aid Scheme 19, % 44, % Naspers Medical Fund 4, % 7, % TFG Medical Aid Scheme 2, % 6, % Anglo Medical Scheme 9, % 20, % BMW Employees Medical Aid Society 3, % 7, % Total 1,336, % 2,861, % 1.2 An overview of the Discovery Health Medical Scheme Distribution of health at 31 March 2014 Number of health overall health Members on Discovery Health Medical Scheme 1,195, % Individual 357, % Employer groups with 35 health or less 221, % Employer groups between 36 and 100 health 86, % Employer groups between 101 and 1,000 health 281, % Employer groups larger than 1,000 health 230, % Page 2

4 The graph below reflects the number of health covered by Discovery Health Medical Scheme as at year-end (or at 31 March 2014 for this report, if not at year-end). Demographic profile at 31 March March March March March 2014 Number of health 1,032,240 1,093,826 1,154,134 1,195,091 Number of health lives 2,270,282 2,380,530 2,494,193 2,569,672 Average family size Average age of health lives Pensioner ratio (percentage of health lives aged 65 and above) 7.4% 7.7% 8.1% 8.5% government employees 2.0% 1.7% 1.5% 1.3% individual health 22.8% 25.8% 28.0% 29.9% employer group health 75.2% 72.5% 70.5% 68.7% Page 3

5 The Discovery Health Medical Scheme offers a comprehensive suite of 21 health plans across the product spectrum. The range of health plans have specifically been designed to cater for the variety of medical and financial needs encountered by the diverse population in South Africa. Health plan at 31 March 2014 Number of health health Number of health lives health lives Percentage year on year change Executive Plan 12, % 27, % -2.4% Classic Comprehensive 171, % 402, % -4.8% Classic Delta Comprehensive 5, % 12, % -1.6% Classic Comprehensive Zero MSA % 1, % 59.8% Essential Comprehensive 22, % 45, % -13.2% Essential Delta Comprehensive 1, % 2, % 4.8% Classic Priority 103, % 237, % 0.4% Essential Priority 9, % 19, % 3.7% Classic Saver 190, % 421, % 8.2% Classic Delta Saver 46, % 95, % 19.8% Essential Saver 56, % 126, % 2.8% Essential Delta Saver 23, % 47, % 28.6% Coastal Saver 168, % 387, % 4.7% Classic Core 43, % 97, % 0.7% Classic Delta Core 7, % 14, % 11.5% Essential Core 18, % 41, % 5.9% Essential Delta Core 10, % 20, % 24.3% Coastal Core 79, % 176, % 5.0% KeyCare Plus 203, % 364, % 1.7% KeyCare Access 4, % 7, % -10.5% KeyCare Core 13, % 21, % -0.5% Total 1,195, % 2,569, % 3.0% Page 4

6 The KeyCare series offers cost effective healthcare cover for the previously uninsured segment of the market and is aimed specifically toward the low income earners. KeyCare has experienced exceptional growth since its inception. The graph below reflects the number of health lives covered under the KeyCare health plan as at year-end (or at 31 March 2014 for this report, if not at year-end). Province at 31 March 2014 Number of health health Percentange year on year change Eastern Cape 58, % 2.5% Free State 32, % 3.7% Gauteng 554, % 3.8% Kwazulu-Natal 184, % 4.1% Limpopo 26, % 4.0% Mpumalanga 41, % -1.0% North West 44, % 2.2% Northern Cape 12, % 5.3% Outside South Africa or not recorded 2, % 116.6% Western Cape 239, % 3.3% Page 5

7 The Discovery Health Medical Scheme provides with access to the highest level of cover when they need it most. 2.1 Hospital admissions Reason for hospital admission for Quarter Chronic Illness Benefit Average cost Liver transplant R895,900 Premature babies smaller than 1 000g with major operations R794,470 Critical care for long-term mechanical ventilation R723,738 Heart transplant R456,390 Major surgical procedures in newborn babies with birth weight greater than 2 499g R417,646 The Chronic Illness Benefit (CIB) covers medicine for a specified list of life threatening or degenerative conditions. Members who are on the Executive and Comprehensive health plans have access to an additional list of 61 conditions on the Additional Disease list (ADL). CIB registrations at 31 March 2014 Number of health Number of health lives health lives Percentage year on year change Registrations on the Chronic Illness Benefit 361, , % 5.0% Prescribed minimum benefit (PMB) conditions - overall 353, , % 4.9% Executive and Comprehensive plans 112, , % -1.9% Other health plans 240, , % 8.7% Additional Disease List 48,542 52, % 26.3% Page 6

8 Conditions registered on the CIB at 31 March Doctor visits Number of health lives registered Essential (primary) hypertension 271,525 Hyperlipidaemia, unspecified 152,448 Asthma, unspecified 88,872 Non-insulin-depend diabetes mellitus without complication 67,656 Chronic ischaemic heart disease, unspecified 42,821 The size and scale of Discovery Health has allowed us to enter into Direct Payment Arrangements (DPAs) with specialists and GPs. This ensures Full Cover choices for our, and higher levels of reimbursement for healthcare professionals on the Direct Payment Arrangements. At present, our payment arrangements cover the vast majority of all Discovery Health visits to GPs and specialists, which has wide geographical coverage across the country. Doctor visits at 31 March 2014 Percentange visits DPA provider visits 86.1% GP visits 83.0% Specialist visits 87.8% Page 7

9 Region Percentage DPA visits Eastern Cape 94.2% Free State 93.4% Gauteng 83.9% Kwazulu-Natal 87.4% Limpopo 90.1% Mpumalanga 91.1% North West 89.6% Northern Cape 81.8% Western Cape 85.9% The Discovery Health Medical Scheme provides with the highest levels of financial security in the medical schemes industry. With over R10.0 billion in reserves and the highest possible credit rating for medical schemes, have absolute peace of mind regarding the Scheme s claims paying ability. Gross Contribution Income and reserves Discovery Health Medical Scheme Gross Contribution Income for 2013 Discovery Health Medical Scheme reserves at 31 December 2013 Rand amount R40,574,581,425 R9,970,118,000 Page 8

10 3.1 Contribution income 3.2 Growth in reserves Page 9

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