CMS releases its 2020/21 Industry Report – 12 October 2021

12 Oct 2021

The CMS 2020/21 Industry Report revealed that the COVID-19 pandemic resulted in claims to the value of R10.10-bn in 2020. According to numbers from the 73 schemes, representing 99.84% of medical scheme beneficiaries 422 894 members of medical schemes were infected with COVID-19 in 2020 and 383 585 recovered with a mortality rate of 3.02%.
The pandemic caused a decrease in healthcare utilisation and expenditure in 2020, due to the varying levels of lockdowns and cancellation of elective procedures and services. Healthcare expenditure on benefits decreased to R178.04-bn, 3.81% down from the 2019 reported amount of R185.1-bn, while hospital expenditure saw a decline of 8.38% between 2019 and 2020, from 68.4-bn to 62.7-bn. The average amount paid per beneficiary for hospital services also decreased by 8.45% to R7 052.00, while over 92% of this expenditure went to private hospitals.
There were also less visits to the doctor as the amount claimed by General Practitioners (GPs) decreased by 10.07% from 10.3-bn in 2019 to 9.21-bn in 2020. There was an overall decline in the amounts paid toward specialists, hospitals, general practitioners, dentists, and dental specialists, 2.26%, 8.83%, 10.07%, 7.19%, and 5.52%, respectively.
The net healthcare result for all medical schemes combined reflected a surplus of R19.93-bn in 2020 (2019: R1.03-bn surplus). The improved performance is because of the lower utilisation of benefits during the pandemic. The 2020 industry solvency ratio stands at 44.55% (2019: 35.61%)., and exceeds the minimum required ratio of 25.00%, consistent with regulation 29 of the Medical Schemes Act (131 of 1998).

To read the report