Policy, Research and Monitoring
Research Reports and Studies
The Research and Monitoring Unit serves beneficiaries of medical schemes and members of the public by collecting and analysing data to monitor, evaluate and report on trends in medical schemes and develop recommendations to improve the regulatory policy and practice.
Research conducted by the unit currently covers the areas of utilisation of health care services in the private sector, strengthening governance in medical schemes by proposing a framework for trustee remuneration and development of a process for measuring quality and outcomes in the private health care sector. Research methods include a combination of literature reviews, consultative processes, surveys, and statistical tools. Research output is often disseminated to the medical schemes industry through the publication of monographs and presentations at industry consultative forums.
Research Report: Improving Healthcare Access through Preventive Interventions: A Comparative Study of Government and Non-Government Restricted Scheme
Healthcare access and utilisation differ across South Africa’s medical schemes, with disparities particularly evident in preventive services, mental health screenings, and HIV testing—especially among men. While some schemes offer broader services, challenges remain in how well primary healthcare (PHC) is integrated and utilised. This study compared government-funded and non-government schemes to identify gaps in service uptake and propose ways to improve access.
The analysis, based on CMS data, revealed that government-funded schemes outperformed non-government schemes in areas such as medical male circumcision, contraceptive use, cervical cancer screening, and use of oral rehydration solutions for children under five. However, they had lower mental health screening rates (80.73 vs. 92.69 per 1,000) and lower male HIV testing (36.13% vs. 43.59%) than non-government schemes. ART uptake was similar across both schemes, averaging around 91%, with slightly higher rates among women.
To improve access and equity, the study recommends integrating mental health into PHC, using gender-sensitive strategies for HIV testing, and adopting successful government scheme interventions in non-government schemes. Preventive care should be prioritised in benefit design, and regular monitoring of service utilisation should guide policy and resource allocation.
Research Notes 2025
Research Notes feature the latest studies from the Council for Medical Schemes.