Private healthcare services would not be accessible to most of those who currently enjoy them if it were not for the support they receive from the medical aid schemes that serve to make them affordable. While some may still consider the premiums of private medical schemes high, they do not compare with the impact of meeting the full cost of a simple procedure from one’s own pocket.

In practice, the companies that provide financial assistance towards healthcare costs generally strive to keep their premiums as low as possible. Despite their best efforts to do so, however, being unable to afford medical aid premiums is a rife reality for many South Africans. The explanation for this failing is twofold, and the one which continues to make it impossible to provide affordable medical aid for everyone is the high and constantly increasing cost of healthcare both in the private and public sectors.

New technologies, such as magnetic resonance imaging (MRI) and computer-aided tomography (CAT) are proving to be invaluable tools for helping doctors to establish accurate diagnoses. Similarly, new medications are becoming ever more effective in treating previously untreatable conditions. However, such innovations regularly come with a high price tag, while maintaining and operating high-tech equipment is an additional ongoing expense. Providing sufficient cover to meet these rising costs is a challenge in itself, but the constraints faced by schemes pose additional challenges in their quest to maintain affordable medical aid premiums.

Unlike insurance companies, not only must all schemes in South Africa accept members with heightened risk due to pre-existing conditions, but they must also apply the same premium price to these as for young and healthy members. In addition, they are legally obliged to provide full cover for the diagnosis, treatment, and care of no less than 25 chronic diseases. This is just a part of the mandatory obligations known as prescribed minimum benefits (PMB) that must be honoured by these not-for-profit companies. In the face of such challenges, it is quite remarkable that fund managers have been so successful in their efforts to keep medical aid premiums as affordable as they still are.

That said, quality is every bit as important as price and, in many cases, the two can be mutually exclusive. This means that, when you are in the market for private healthcare cover, you should not allow yourself to be influenced by the monthly premiums alone. There are two important questions to ask before making your decision. What will I be getting for my money and who will I be depending on to provide it?

It is the value of the benefits you and your dependents will receive that, together with the premium price, will determine just how affordable your medical aid will be. That said, it will be the choice of cover provider that determines if it is a sound investment.

Trusted by South Africans for more than 50 years, Medshield Medical Scheme currently provides cover for more than 160 000 main members and dependents, and has long enjoyed an AA- Global Credit Rating. Together with an above-average solvency ratio, this provides the assurance to those who choose to obtain their affordable medical aid from Medshield that their valid claims will be met.