The CMS Industry Report 2023 is here!
The Council for Medical Schemes (CMS) is pleased to announce the release of the 2023 Industry Report together with Healthcare Utilisation Annexures.
This highly anticipated Industry Report provides a comprehensive overview of key trends, including demographic shifts, benefits paid, and other critical aspects of South Africa’s medical schemes industry.
Demographics
The downward trend in the number of medical schemes continued in 2023, decreasing from 72 to 71 schemes. However, the industry experienced growth in the total number of beneficiaries. Despite this increase, the proportion of beneficiaries covered by medical schemes relative to the national population declined, falling from 16% in 2000 to 14.7% in 2023.
Open schemes offered three times more benefit options than restricted schemes, with seven versus two for open schemes, highlighting a significant disparity in the flexibility and diversity of offerings across scheme types. Similarly, open schemes had a share of 53% of the medical scheme population compared to 47% of restricted schemes.
The average age of the medical scheme population remained the same at 34 years, and female medical scheme members continued to have a higher average age of 35.2. The pensioner ratio slightly increased from 9.3 to 9.4 in 2023.
Gauteng province continued to dominate, with almost 40% of beneficiaries, underscoring the correlations between economic activity and medical scheme membership. Western Cape and KwaZulu-Natal came in second and third, with 15% and 14%, respectively. The Northern Cape had the lowest number of beneficiaries, with 2%.
Healthcare benefits
According to the Industry Report, the total healthcare expenditure on benefits paid in 2023 increased to R239.0 billion, up by 9.44% from R218.4 billion in 2022. The claims paid per average beneficiary per annum (papa) increased by 8.2% fromR24 394.75 in 2022 to R26 404.79 in 2023, and benefits paid from medical savings accounts (papa) increased by 7.4% to R2 547.17 in 2023 from R2 374.48 in 2022.
Risk benefits paid remained at 90% of total benefits paid, with savings at 10% and an increase of 8.3% from R22 020.27 in 2022 to R23 857.61 in 2023 per beneficiary. Total hospital expenditure accounts for 39.22% of risk benefits paid with all specialists accounting for 28.61%, followed by medicine dispensed at 11.79%.
The largest component of out-of-pocket payments (OOPs) remains that of medicines dispensed, which constituted 35.09% of OOPs in 2023, which is only marginally lower than the 35.37% recorded in 2022. The estimated out-of-pocket payments paid to specialists increased slightly between 2022 and 2023, recording 26.83%and 27.59%, respectively.
Chronic conditions
Hypertension, hyperlipidaemia and diabetes mellitus type 2 remain the most prevalent conditions on the CDL of medical schemes. Haemophilia had the highest expenditure per patient treated (although it has the lowest prevalence), followed by chronic renal failure and multiple sclerosis.
The Industry Report found that expenditure on most chronic conditions increased from 2022 to 2023, with the highest reported increases seen in Human Immunodeficiency Virus (HIV), Chronic Obstructive Pulmonary Disease (COPD), and Haemophilia (HAE) at 20.6%, 17.0%, and 14.7%, respectively.
Download the Industry Report here and the Annexures here.
The report on the industry’s financial performance will follow in due course. Despite IT delays affecting online submissions from schemes, our team is working diligently to complete the analysis and make this information available.
