Private medical aid membership

What is the impact on health care use and out-of-pocket payments in South Africa?

In South Africa, medical scheme membership does not guarantee lower out-of-pocket payments. Fees charged by private health care providers have increased and generally exceed the amounts that medical schemes are willing to pay for. Scheme members have to make substantial co-payments. A form of insurance that ensures adequate use of health services is needed. Ideally, this should be a form that ensures universal access to health care, for example, the proposed National Health Insurance. Policy recommendations include the need to move away from fee-for-service payments, and that health insurance should not only ensure adequate use of health services, but also provide financial protection to the insured. The NHI should ensure that out-of-pocket payments are limited. Read more here .

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