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For over 18 months, Schemes in South Africa have had to manage the impact of this virus on overall claims and project future claims patterns considering the infection rates, severity levels, treatment costs, duration, and levels of Prescribed Minimum Benefits (PMBs) that apply.

It is reassuring to see, then, that Bestmed has stayed resilient and shown growth despite the tough times.

According to guest speaker, Christoff Raath, Joint CEO of Insight Actuaries and Consultants, “it is both the worst time and the best time to be an actuary because of the many uncertainties pulling in many different directions, uncertainties which are brought about predominantly by COVID-19.” Raath added that some of these uncertainties include:

1. Uncertainty over the development of more COVID-19 waves.
2. Long-term COVID, which is not fully understood yet.
3. Long term vaccine efficacy.
4. The need for booster shots and how much it will cost.
5. More strains of the virus developing.
6. Withdrawals due to the tough economic climate resulting in healthy people resigning from their medical aid because of unemployment or unaffordability.

Raath further explained that; “medical schemes are now sitting at record solvency levels and Trustees are legitimately asking how these record highs can be used to help medical scheme members.”

He was speaking at the ‘2022: Emergent Themes, Trends and Uncertainties in the Medical Schemes Sector’, webinar, hosted by the Institute of Health Risk Managers (IHRM) recently.

While schemes have healthy reserves and indeed exploring ways to transfer this to the members, it is difficult to judge the rate at which these reserves must be used given the uncertainly of a COVID-19 future. Certain schemes have used their reserves to keep annual contribution increases below inflation. While this will work in the short-term, the long-term risk is that this could result in low solvency issues in the future.

Some people, for different reasons have not accessed healthcare services – some reluctant to go to the health practitioners and medical facilities for fear of contracting COVID-19. The long-term effects of deferring health services are yet to be understood. It is envisaged that this could culminate in more severe health issues down the line.

The utilisation of health services could soon change, as more people get vaccinated, translating into what will be the new normal. This could result in a correlating increase in people seeking normal day-to-day healthcare and going for elective surgery. It could also mean that people may feel different about belonging to a Medical Aid. The industry could experience higher resignations (i.e. no membership growth) especially given the current challenging economic climate – another possible long term impact of COVID-19.

Bestmed Medical Scheme, South Africa’s largest self-administered scheme, and the 4^th largest open medical scheme, was the only one of the top five open schemes that experienced growth in 2020 according to a recent report by the Council for Medical Schemes (CMS). This growth may be related to Bestmed being rated as the leader in the South African customer satisfaction index (SA-csi) for 2021.

According to Leo Dlamini, Bestmed CEO, and Principal Officer “the importance of the role that medical schemes play in the lives of its members was amplified in 2020 and 2021 with the outbreak of the COVID-19 pandemic and the three COVID-19 waves. Bestmed has not been spared from the impact of COVID-19 and the Scheme has paid for more than R800 million in COVID-19 related costs” he stated at the Bestmed Medical Scheme Product Launch 2022.

Bestmed is also proud to lend a helping hand to its members by posting a record low 3.9% contribution increase, the lowest in the Scheme’s recent history for a second consecutive year. "The uncertainties in the sector are worth noting and planning for, but Bestmed is prepared. Being a self-administered Scheme means that we control the managed care organisation, we are flexible and agile enough to respond to members needs as and when required,” he adds.