Is Medical Aid Necessary?

Private medical aid is not compulsory for South Africans but is often considered as a necessity by most given the overburdened public health system. Medical aid is a form of insurance that differs from medical insurance and national health insurance. The latter, national health insurance, is not as yet available in South Africa (2011). However, it has been planned for the near future and this will most likely be necessary for all South Africans irrespective of whether they have private medical aid or not. For now, and for most of the foreseeable future, medical aid will be the tool to access quality healthcare without the restrictions that befall many who opt for public healthcare.

Medical Aid Structure in South Africa

Medical aid is a form of insurance that covers the costs of medical care. Understanding the structure and benefits of a South African medical aid will a person decide if cover is necessary for them or not. Some plans may provide comprehensive cover with benefits for out-of-hospital and in-hospital services while other plans are restricted to only in-hospital care only. Choosing between the two types of cover largely depends on a person’s budget and the needs of the members.  A medical aid covers health costs up to a certain limit and according to predetermined tariffs as listed in the National Health Reference Price List (NHRPL). These prices change annually. Some doctors and facilities may charge above and beyond these prices and while some medical schemes cover the higher costs, in most instances it is up to the patient to pay the difference in cash.

Medical aids may pay a doctor, other healthcare provider, pharmacy or hospital directly if the practitioner or facility is contracted into medical aids. If not, a person will have to pay in cash for these services or medication and then claim back the money from their medical aid. Medical aid cover does not pay for every healthcare service, medication or procedure. While all life-saving and essential medical costs are covered, other non-essential or cosmetic services are not paid for by medical aids. Prescribed minimum benefits (PMBs) are a list of conditions which all medical aids must cover throughout a year irrespective of the availability of benefits for the year.

The Advantages of Medical Aid

Considering the level of cover afforded by a medical aid, it is easy to see why many consider it a necessity. Private healthcare costs in South Africa are fairly high and unaffordable to most. While medical aid cover itself does not come cheap, the level of financial protection that it offers can be a lifesaver when you need it the most. For many, medical aid does not seem as a necessity when young and healthy but any mishap can befall a person and the costs of seeking private care can be exorbitant.

Medical aid allows one to access private healthcare services and facilities. This is also available to non-medical aid members but has to be paid for in cash and often upfront. Without medical aid cover or the cash to pay for private health services, one has to seek assistance from the public healthcare system. Unlike many developed countries, South Africa’s healthcare system is often considered as substandard. It services the needs of majority of the South African population and is known for its overburdened facilities which are at times poorly equipped and maintained with staff lacking the morale or accountability of the private health system.

This ultimately determines the level of care and while both national and provincial government are making efforts to improve the level of care, it is still a far cry from the private health system in South Africa. Should one not have medical aid cover, they will automatically be routed to a public hospital if they do not have an upfront deposit for a private hospital. Service providers such as doctors may be a bit more flexible with non-medical aid patients and their services may be affordable but to most, the cost of care in a private hospital is exorbitant.

Irrespective of youth and a person’s current health status, there is no saying when medical care may be needed. Even if it is not a disease, medical care may be required after an accident or by being a victim of crime. Without medical aid, one has to resort to the public health system and often bear the brunt of a overburdened facilities and overworked staff. Medical aid makes the difference in quality care and peace of mind when one needs it the most.