Money's tight for most people at the moment. Everyone's cutting corners and cutting down on things that are thought not to be essential.
And what's more medical schemes in SA are said to be five times more expensive than elsewhere in the world, when purchasing power is taken into consideration.
The cost of private medical care has been higher than the normal inflation rate for the last few years. A comprehensive medical scheme just for yourself could easily put you back between 10% and 20% of your income every month. Many people are scaling down to a hospital plan to save money, and many others are simply doing without a medical scheme of any kind - and hoping for the best.
"Your medical needs should be considered first and foremost," says Johan van Tonder, independent medical scheme researcher. "If you're healthy and don't suffer from any chronic diseases, a hospital plan might be enough. However, if you're older, you might be more prone to chronic conditions, which might bankrupt you if you have no cover for out-of-hospital expenses."
In the case of those who have no cover, the cost of injury or emergency surgery could be crippling. While some state hospitals offer excellent services and facilities, many don't. And paying for a private hospital out of your own pocket could set you back the price of a good second-hand car. That is, if it's not a big operation. Then we're looking at a new one at least.
Whichever situation you're in, there are ways that you can get the treatment you need without being completely crippled by the cost. But you need to know how.
What you can do
Here are some ideas:
Stick with the company medical scheme. This is often cheaper than going for an open-market medical scheme, where you as an individual may have little bargaining power. Also, closed schemes often charge you according to your income, but everyone gets the same benefits. So it's good for lower and middle income earners. Open schemes charge a set fee for a particular option, regardless of your income. If there's a clinic at work, use it. It's probably free.
Stick together. If you have two children and a spouse, it will be cheaper to all be on the same medical scheme than if you or your spouse join different schemes as principal members. Even if your company insists on your joining their scheme, you can usually get out of it if you're on your partner's scheme as an adult dependant. There are some options where you only pay for one or two children and the rest are free. Just check that you won't get a better deal if you move everyone onto your in-house scheme.
Shop around. If you have to paddle your own canoe as far as a medical scheme is concerned, shop around. You need to find one that suits your needs. Some medical schemes have high premiums, but also have a wider range of benefits for specific categories of treatment. If you don't get ill often, it might be worth your while to go for a medical scheme on which premiums are low, there is good hospital cover, but which is low on day-to-day cover. If you need ongoing medical care, though, you will need a scheme with higher day-to-day limits. An idea is to go to an independent medical-schemes broker, who could help you make sense of the many different possibilities.
Chronic medication costs. The list of chronic conditions or PMBs (Prescribed Minimum Benefits) indicates which conditions medical schemes have to continue treating - even if an individual member's benefits have run out. If you suffer from one of these conditions, ask your GP whether there is a suitable generic for the medication he/she is prescribing for you. In this way you can keep the costs down.
Use your benefits. If you have an over-the-counter facility on your medical scheme, use it. The R100 you save on vitamins by not paying for them out of your own pocket could be spent on petrol in those last three desperate days before payday. Also don't go over your limits if you can help it - if the medical scheme covers up to R800 for frames for your new glasses, take the best you can find in that price range.
Get a hospital plan. If you have no medical scheme, because you think it's too expensive, try a two-week stay in a private hospital after an accident. A hospital plan is a lot cheaper than a full a medical scheme, but go for one that covers you from day one, otherwise there's little point. Many schemes have very reasonable hospital plan options if you are prepared to go to a particular hospital chain for elective procedures (not for emergencies). This allows the scheme to negotiate bulk discounts. Make use of this.
Read: Hospital plan vs. medical scheme
Get your facts straight. Unless there's a medical emergency, don't be shy to ask exactly what your hospital plan or medical scheme will cover before you're admitted to a private hospital. This isn't the time to be modest. What some people do, if they have no cover, is to have the operation done in a state hospital, and to go to a private hospital to recover from it. Post-operative care is often a problem area in state hospitals, usually not the operations themselves.
Find a reasonable chemist. On certain medications – both prescription and over-the-counter (OTC), prices can vary enormously from chemist to chemist. The one closest to your house may not be the cheapest. You could be paying a fortune for convenience. Large pharmacy chains are always the cheapest, as they can negotiate lower prices on bulk purchases. They also often charge lower levies than your corner chemists.
Read: How to find the right pharmacy
Phone your doctor. You might have to leave a message for him/her to call you back, but it might be an idea to speak to the doctor first to find out whether a visit is really necessary. You might just have the stomach bug that's doing the rounds, and for which you could pick up something at the chemist. Don't make a habit of phoning the doctor all the time, though. They are busy and don't much like interruptions. But once or twice a year is fine.
Check out the state hospitals. If you have no medical aid, consider going to a state hospital, but check them out first. Some of them are very good, although hardly luxurious. But then, when you need to have your appendix out, who cares about plush carpets and elevator music? Ask your GP which hospital he/she recommends. And on this topic - contraceptives are free at government clinics, which are sometimes located in state hospitals. Most schemes will not pay for these. Queue for a while and save yourself some money.
Check out your supermarket. Many OTC medications are available at supermarkets. Things such as headache tablets, vitamin pills and antacids are generally much cheaper at the supermarket than they are in the chemist, as the supermarket buys these things in bulk.
Look at generics. Generic medication have the same active ingredients as the original brand, but without the brand name. They can cost a fraction of the price. This will increase the time you may take to reach your claim limits in certain categories, leaving you covered for longer. Many schemes already insist that you use these, unless there's a medical reason not to do so. If you are unsure, do ask your doctor or pharmacists.
Take your own supplies to the hospital. Find out in advance what you'll need – tablets, cotton wool, bandages, antiseptic – and take them with you. Hospitals are notorious for charging you for a whole packet of earbuds if you used only three of them.
Audit your hospital bill. Get your medical scheme to help. If there are inconsistencies, a complaint from them will probably have more clout than a complaint from a single individual. Schemes are usually helpful in this regard, because ultimately they are the ones footing the bill.
Go for the GP who charges medical-scheme rates. This could save you an enormous amount of money. The last thing you feel like doing is paying 70% of the bill for seeing your gynaecologist or GP. Get someone who is contracted into the medical scheme, so the bill will never even be sent to you. Ask your medical scheme for a list of doctors from which you can choose. Also remember that you can often negotiate tariffs - these are not set in stone. What to ask your GP or pharmacist.
Get access to medical information. In a non-emergency situation, a reliable website, such as Health24, or a good medical reference book may answer some of your questions without your having to incur the cost of going to the GP. Reputable sources of medical information will also tell you when you should go to the doctor, as mere information can never take the place of face-to-face medical treatment when it's necessary.
Ask your pharmacist. Pharmacists can often give good medical advice about things such as skin rashes, flu, or minor infections. Ask your pharmacist about over-the-counter medication or self-treatment for minor ailments. Pharmacists are also often open after hours. Most big cities have all-night chemists with a pharmacist on duty. Clinic sisters can often also give you injections, or take your blood pressure, or do simple tests – you might only have to pay for the medication, not a full doctor's consultation.
Deal now with medical issues. Ignoring a medical problem, because you don't want to pay the GP, often means that you end up paying for three consultations, because the condition has gone from mild to serious as a result of being neglected. If something's wrong, it's simply cheaper to deal with it right at the beginning. But learn to distinguish when it's serious, and when it's not.
Avoid after-hours consultations. Obviously, if there's a crisis, you'll have no choice. But going to the GP at the 24-hour clinic on a Sunday morning, because you have a sore throat, is going to cost you a lot more than it would on Monday morning.
Look after yourself. Prevention is always better than cure. Taking a good multivitamin, eating fresh fruit and vegetables, getting exercise, not having unprotected sex, sleeping enough, not smoking, not drinking excessively and learning to relax, are all things you can do to prevent yourself from being infected by opportunistic viruses and bacteria. The healthier you are, the lower your medical costs will be.
Medical savings account. If you have depleted your medical savings account, continue sending receipts of bills you have paid to the medical scheme. In that way they will know when you have gone through your self-payment gap, and the benefits could kick in again.
- (Susan Erasmus, Health24, updated February 2014)