/ 13 June 2011

Members say medical schemes too expensive

If you feel your medical scheme is too expensive, you’re not alone — the 2010 OMAC Actuaries & Consultants Healthcare Monitor survey, released today, reveals that three quarters of the 1 002 respondents who were interviewed feel the same way.

But this could be because members are on too rich an option for their benefit needs, says Margaret Hulme, head of Healthcare Consulting at OMAC. Members tend to lack awareness as to their options, so they opt for a “safe rather than sorry” approach when choosing an option.

Another important finding suggests that members don’t like cost-saving initiatives like Designated Service Providers (DSPs) because they don’t like the perceived lack of freedom of choice, particularly when it comes to GPs. DSPs help to control costs, but members simply feel they are being “controlled” when it comes to choosing a GP.

Hulme says that although 84% of members believe that their scheme offers good value for money, they also believe that more expensive options with more benefits and without DSPs are providing the best value for money. This is in spite of the rich set of prescribed minimum benefits (PMBs) that must, by law, be provided by all schemes and benefit options.

“In reality, the options with lower benefits and DSPs are probably providing the better value for money because these options generally contain a healthier pool of lives and must also cover the full list of PMBs,” Hulme says.

Members surveyed prefer higher monthly contributions and fewer co-payments to lower monthly contributions and more co-payments. This may explain the apparent preference for more comprehensive, expensive options.

Hulme says schemes need to communicate the positive reasons for controls such as DSPs so they don’t alienate members. But as only 44% of members read their member guides, this probably isn’t the way to communicate. Ironically, members who complained about claim payments said if they had read their member guides in the first place they would have been less unhappy.

Half of members don’t make use of their broker or the internet to improve their understanding, so it’s difficult to work out the best way of informing members. Call centres were the worst-rated area of service, according to the survey.

As a result, one third of members said they don’t know what they are covered for and only find out when they claim. A third of members said they find the benefit structures confusing.

Switching to other schemes or options doesn’t seem to be all that popular, though. “Of the members surveyed, 91% had not changed scheme or scheme options in the last three years — however, when comparing the price and their benefits of their old versus the new options, it emerged that members favour better value rather than lower cost,” says Hulme.

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