Categories: LifestyleNews
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2023-12-09 8:22 AM

South Africa’s Top Medical Schemes: Discovery, GEMS Dominance

  • South Africa's medical schemes industry showcases a notable consolidation trend over the years, with a decrease in the number of schemes from 144 to 72, while beneficiaries surged from 6.73 million to 9.04 million.
  • Key players like Discovery Health and Government Employee Medical Scheme (GEMS) continue to dominate, with Discovery leading as the largest scheme, while GEMS stands out among restricted schemes, illustrating a concentration of membership among a few major entities.
  • The top 10 schemes account for a substantial 80% of total membership, emphasizing the significant market share held by a handful of medical aid schemes in South Africa.
By Miriam Matoma

The landscape of medical aid schemes in South Africa has undergone significant shifts in recent years, mirroring a dynamic evolution in membership, beneficiaries, and the overall structure of healthcare accessibility. The Council for Medical Schemes (CMS) has meticulously documented these transformations in its latest report, shedding light on the changing contours of the country’s healthcare insurance sector.

Throughout the 2022/23 period, the CMS maintained oversight over 72 regulated medical schemes, a slight decrease from the previous year’s count of 75. This reduction is part of a broader trend marking the gradual consolidation of the industry, which has halved in size over the past 22 years. In the year 2000, there were 144 schemes under CMS regulation, a number that has now dwindled to 72. However, amidst this consolidation, existing schemes have diversified their offerings, expanding from an average of five plans in 2000 to an average of seven in 2022/23.

Despite the decline in the number of schemes, there’s been a noticeable uptick in beneficiaries, soaring from 6.73 million to 9.04 million over the years. This increase is indicative of a growing reliance on medical aid schemes for healthcare provisions in the country.

Significant shifts in membership have been observed among various schemes. Bestmed emerged as the forerunner in growth, boasting a remarkable 10% surge in its membership. Conversely, schemes like Sisonke Health Medical Scheme and Transmed experienced a decline of 12%, marking them as the most impacted entities in terms of membership reduction.

The dominance of certain key players is striking in South Africa’s medical scheme landscape. Discovery Health remains the largest scheme in the country, witnessing a steady increase in both members and beneficiaries. Accounting for approximately 58% of open scheme members, Discovery continues to consolidate its position as a pivotal player in the industry.

In the realm of restricted schemes, the Government Employee Medical Scheme (GEMS) stands as the towering figure, encompassing a substantial portion of restricted scheme members and beneficiaries, capturing around 46% and 51% respectively.

The concentration of membership within a handful of schemes is a noteworthy trend, with only seven out of 72 schemes boasting memberships exceeding 100,000, and a mere 13 surpassing the 100,000 mark in terms of beneficiaries. Remarkably, the top 10 schemes command a staggering 80% of the total membership in the country.

To provide a comprehensive view, here’s a ranking of the 20 biggest medical schemes in South Africa, showcasing their membership and beneficiary numbers:

#Medical SchemeTypeMembersBeneficiaries
1Discovery Health Medical SchemeO1,360,0452,788,312
2Government Employees Medical Scheme (GEMS)R787,4802,083,603
3Bonitas Medical FundO353,905729,904
4SA Police Service Medical Scheme (POLMED)R177,166491,509
5Momentum Medical SchemeO156,044296,119
6LA-Health Medical SchemeR94,697240,457
7Bestmed Medical SchemeO109,806228,968
8BankmedR104,728216,678
9MedihelpO90,871198,501
10Sizwe Hosmed Medical FundO63,577152,421
11Medshield Medical SchemeO72,807145,710
12Fedhealth Medical SchemeO65,217122,943
13Platinum HealthR56,036100,964
14Umvuzo Health Medical SchemeR47,88886,188
15SasolmedR29,27477,561
16SAMWUMedR35,71576,716
17ProfmedR36,22774,589
18KeyhealthO34,73673,161
19Chartered Accountants (SA) Medical Aid FundR25,68347,005
20Remedi Medical Aid SchemeR20,36545,280

This breakdown underscores the substantial market share held by key players and illuminates the considerable impact these entities have on the nation’s healthcare landscape.

In navigating South Africa’s healthcare terrain, understanding the dynamics, strengths, and offerings of these major medical schemes becomes pivotal. The healthcare choices of millions of South Africans are intertwined with the policies, benefits, and services provided by these schemes, making their evolution a critical aspect of the country’s healthcare narrative.

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Miriam Matoma

Miriam is a freelance writer, she covers economics and government news for Rateweb. You can contact her on: Email: miriam@rateweb.co.za Twitter: @MatomaMiriam