For many cash-strapped South Africans, having medical aid may seem like a luxury. What are your options if you simply can’t afford it? We look at ways that you can slash your medical bill without compromising your health.
Last year Lidia Mohammed gave birth to her baby boy in a government hospital. “It was fine,” she recalls. “I had my own room with a nurse with me the whole time.” But the 36-year-old former PA says her stay wasn’t without drama. “The nurse left to go home just before I gave birth, at the time I needed her most. We had to call her back,” she says. She and her husband had to deal with lots of student doctors who came and went and she admits that most of the doctors were quite rude. “They didn’t ask for my consent before they performed certain procedures and they didn’t bother telling me what they were doing,” she remembers. “Many think you are ignorant because you can’t afford medical aid.”
Her experience at a state facility resonates with others who, for financial reasons, are deprived access to private health care. It’s an unfortunate reality in South Africa that only 13% of the country’s population can afford to belong to a medical aid scheme. The remaining 87% have to rely on alternatives, such as health insurance or public health care.
What are your options?
“While medical aid is by far the most appropriate method of ensuring that you are covered for health eventualities, there are other ways in which consumers can mitigate against being faced with huge bills for health conditions,” says Heidi Kruger of the the Board of Healthcare Funders of Southern Africa. “One of these is a savings account which should be earmarked for health issues and which individuals should put money into each month.”
Another option is to take out medical insurance with an insurance company. “There are a wide range of health insurance products on the market, including products for primary health care (e.g. GP visits, dental care and medication), hospital cash plans and emergency cover,” explains Dylan Garnett, deputy CEO of Metropolitan Health.
The benefit of medical insurance is that you can choose where you want an operation to be performed. In addition, you may keep any surplus amount over and above the cost of the procedure that the insurance pays out in a lump sum. Some insurance companies also offer no-claims bonuses.
But consumers need to be aware that the level of cover offered by medical insurance is not the same as that given by medical aids. “Health insurance products can refuse cover to bad risks and can also charge different premiums to their policy holders,” says Garnett. This is different to a medical aid which has to charge the same rates according to the scheme its members choose and is not allowed to refuse anyone membership based on age or risk. It is also obliged by law to cover a list of 200 medical conditions, known as Prescribed Minimum Benefits. “With health insurance products, benefits are often limited to a specified sum assured and will not cover the full cost of treatment,” Garnett adds.
Can you insure for certain medical conditions?
Yes, to an extent you can, but be aware of the limitations. “There are a number of health insurance products that provide for specific conditions or types of benefits, such as cancer or dental insurance,” says Garnett.
But this approach can be risky. “You do not know what might happen in future with your health and once you get ill, you might not have any cover for a specific medical condition,” says Dr Elsabe<acute accent on the last ‘e’> Conradie of the Council for Medical Schemes.
What happens in the event of an unforeseen illness?
If you don’t have any form of medical cover, you may be caught short in the event of an accident or unforeseen illness. “This is not a good position to be in,” says healthcare expert Len Deacon of Len Deacon & Associates. Your only options at this stage are state facilities or to foot the bill of private health care yourself, bearing in mind that a week-long private hospital stay can cost in the region of R100 000.
As soon as you can afford to do so, your best long-term option is to join a medical scheme, even if you choose a basic hospital plan. As Deacon says: “Younger people feel that medical scheme contributions are a grudge purchase, but as you get older you will get more medical claims and if you have not been a member before, you will be excluded for certain conditions for a period and be charged a penalty up to 75% of your monthly contribution every month going forward.”