South Africans consider primary healthcare as an alternative to no medical cover

Johannesburg - South Africans are facing a cost-of-living crunch, with research from Visa South Africa and Discovery Bank[i] showing that they are spending 47% more on groceries since 2019. Under this existential pressure, the already low percentage of South Africans with access to medical cover is likely to drop still further as householders look for ways to cut costs.

“Only 16.1% of South Africans have cover from a medical scheme[ii], which is already frighteningly low, but the dire economic circumstances in which so many find themselves will surely push the figure even lower. The big question then is what alternatives do hard-pressed families have when it comes to more affordable medical cover,” says Conita Van Rensburg, Operations Executive at Unity Health. “South Africans who cannot afford medical aid could consider primary healthcare as an alternative. It provides good basic cover and can be complemented with a hospital plan.”

Primary healthcare is an insurance product, and therefore does not replace or replicate a medical aid. Although primary healthcare policies vary, they basically provide cost-effective cover for day-to-day out-of-hospital costs, which may include visits to a general practitioner, basic and emergency dentistry, some optometry and emergency hospital care.

Primary healthcare insurance does not cover private hospitalisation for non-emergencies or elective procedures. Anybody wanting access to private hospitalisation would need to take out a separate hospital plan.

Charleen Rix, Head of Sasfin Health Consulting, cautions that consumers should take advice from a healthcare advisor before deciding on the right option for their families.

“It’s vital that one understands exactly what primary healthcare insurance covers and what it does not, and that they properly understand how healthcare insurance differs from a medical aid,” she says. “Many people take out primary healthcare insurance and then try to take out medical aid cover when they are diagnosed with a serious medical condition, only to find that they are subject to exclusions and contribution penalties,” says Rix.

Rix says, “It’s important to note that to keep health insurance products affordable, they are mostly focussed on expenses such as general practitioner consultations, prescribed medication, basic dentistry and optometry cover. The benefits are subject to network provider rules, including a limit for emergency hospitalisation stabilisation because of an accident or trauma.” So, these healthcare products would not be ideal for individuals with excessive healthcare costs from chronic conditions or oncology. However, relatively healthy individuals might find it a good option if they cannot afford medical aid.

Van Rensburg says, “Those considering primary healthcare insurance should take steps to make themselves even less likely to need advanced medical care. Such steps would include regular health screening, which would include blood pressure, cholesterol, glucose levels, body mass index and HIV. All of these would be included in the primary healthcare policy.”

“Regular screening combined with a sensible exercise regime and eating healthy will go a long way towards ensuring individuals avoid many serious health hazards,” concludes Van Rensburg. “Having some form of medical cover is important, and I reiterate the need to consult a reputable broker to understand what options are available and which will suit you.”