National Health Insurance
Beneficiaries Covered by Medical Schemes
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Determining the number and proportion of people in medical schemes over time needs to be done with some care. A common source for this information is StatsSA publications but from 2005 onwards these estimates have been too low. The most recent StatsSA historic estimates 2 are contrasted with the better information available directly from the Council for Medical Schemes (CMS) in the two graphs below. CMS collects the exact number of members and beneficiaries in medical schemes while the StatsSA figures are from surveys of a relatively small number of households.
Figure 2 : Comparison of Medical Scheme Coverage from StatsSA and derived from Council for Medical Schemes
The CMS data is not without difficulties: until 2005 the numbers in registered medical schemes were shown as well as those covered under bargaining council schemes (the definition of these “exempt” schemes has changed over the years, particularly from 2000 onwards). However even in the absence of bargaining council scheme data for 2006 to 2008, there is a clear increase in the officially reported figures, which are shown as at 31 December each year. This is largely due to the introduction of the Government Employees Medical Scheme (GEMS) from January 2006 which has brought many previously uncovered lives into medical schemes. The StatsSA estimates are from General Household Surveys of typically around 30,000 households which are then re-weighted to the total population. The first graph clearly shows that since 2005 the StatsSA figures have under-estimated the numbers of people covered by medical schemes.
The proportion of the population covered depends on the base population figure used. The historic StatsSA figures reported in 2008 2 use the mid-year population figures before the 2008 revisions 3. Using the ASSA2003 mid-year population estimates 4 and the CMS figures , the graph on the right shows the likely proportion on medical schemes. The best estimate of the proportion of the population on medical schemes is 15.9% in 2008. There is very little difference between using the revised StatsSA mid-year population and the ASSA2003 population over this small range.
Bargaining council schemes are set up by collective decisions of employer organisations and trade unions under the Labour Relations Act rather than the Medical Schemes Act. There have been extensive discussions between the Council for Medical Schemes, the Department of Labour and bargaining council stakeholders over the extent to which these schemes should be treated as part of the medical schemes environment 5. CMS reported on results for 12 bargaining council schemes in 2004 but has subsequently ceased publishing information on the number of schemes and beneficiaries 6. It has been reported that there were 34 such schemes in 1994 7 but more recent data is very difficult to find.
If it is assumed that bargaining council schemes cover at least 250,000 beneficiaries (the levels reported in 2002 to 2004 by CMS), then the overall proportion of the population covered by pre-paid health insurance would increase from 15.9% to 16.4% in 2008. Note that these figures are higher than quoted by researchers who have relied on the StatsSA figures which showed coverage dropping as low 13.7% in 2006. The use of survey data is a less reliable estimate of medical scheme coverage over time.
It is strongly recommended that coverage in medical schemes is derived from Council for Medical Schemes figures and the ASSA2003 mid-year population. An alternative acceptable methodology is the CMS data with the StatsSA mid-year population, as re-estimated in 2008.
See IMSA Glossary of Healthcare Financing Terms on the web-site: www.imsa.org.za
Technically, the CMS beneficiary figures are at 31 December, except for the 2008 figure which is at June 2008. In this analysis the mid-year medical scheme population has not been estimated for 2002 to 2007.
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