What is the optimal mix of healthcare solutions for employers and employees?
Employers and employees alike never know what the ideal healthcare solution set for a group of employed individuals is. Medical schemes, primary healthcare insurance, hospital plans, gap cover – it is all too confusing; therefore, they disengage. Because of a lack of knowledge and the perception that medical schemes are cost-prohibitive for members, we see the trend of switching to low-cost options, hospital plans and medical insurance. In fact, cost should not be the only deciding factor; needs should be at the centre of this decision-making.
The above illustration of available healthcare solutions at varying income and cover levels indicates the array of options available to employers and their employees. Some of these offerings are typically employer-initiated (on-site clinic), while others can be purchased on a group basis or as individuals. Generally, contribution discounts can be negotiated on a group basis. Yet with medical schemes, compulsory group membership does not offer any specific benefits, other than underwriting concessions.
The prevalence of out-of-pocket funding is not shown here and the general consensus in the industry is that out-of-pocket expenditure is at least equal to 10% of medical scheme funding, and constantly increasing.
Good advice to employers and employers will always include conducting a proper needs analysis, considering cost, access and quality, the three pillars of any healthcare solution.
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