Healthcare Utilisation & Benefits Paid Annexures

The non-financial part of the Industry Report, which outlines the utilisation of services by medical scheme members and benefits paid to medical service providers for 2021-2022, has been finalised by the CMS. An update in this regard was provided before and during the launch of the Industry Report on 13 December 2023. However, the completion of the report and respective annexures was postponed due to system-related challenges. The data on the annexures serves as a crucial benchmark for medical schemes in evaluating their performance within the medical schemes industry.

The medical scheme utilisation and benefits paid information is instrumental in evaluating utilisation and expenditure patterns, particularly concerning medical service providers, and illustrates the extent of out-of-pocket payments that medical scheme members are exposed to. It is imperative to note that the utilisation statistics were collected through a Dynamic Database Driven Annual Returns (DDDR) system rather than the financial information. Consequently, the numbers may not always be aligned. Thus, caution should be exercised during the interpretation of the data.

The CMS expresses gratitude for the cooperation from medical schemes, administrators, and, most notably, data officers who were available and adhered to stringent and tight timelines. Their commitment has been instrumental in the successful completion of this vital undertaking.

Access the Annexures here