Abstract:
BACKGROUND : South Africa has a dual healthcare system comprising of private and public sectors covering 16% and
84% of the population, respectively. Medical schemes are the primary source of health insurance in the private sector.
The aim of this study was to assess members of medical schemes’ perceived knowledge and satisfaction with their
medical schemes.
METHODS : A cross-sectional survey was conducted using a stratified systematic sample of members of 22 open medical
schemes. Medical schemes members completed an online questionnaire on knowledge and satisfaction with their
medical schemes. We calculated a composite perceived knowledge and satisfaction score. Descriptive, bivariate and
multivariate analysis was conducted.
RESULTS : A total of 336 members of medical schemes participated in this study. Respondents generally perceived
themselves to have good knowledge of their medical schemes. Eighty-one percent of participants were satisfied with
the quality of services received from their designated service providers (DSPs), however, only 9% were satisfied with
accessibility of doctors under their DSP arrangement. Twenty-five percent of respondents were satisfied with scheme
contributions and only 46% were satisfied with the prescribed minimum benefit package.
CONCLUSION : Medical schemes remain a key element of private healthcare in South Africa. The analysis shows that
medical schemes, should put more effort into the accessibility of general practitioner under their designated service
providers. Furthermore, the prescribed minimum benefits should be reviewed to provide a comprehensive benefits
basket without co-payment for members as recommended by the Medical Schemes Act Amendment Bill of 2018.
