Funding of Oncology Benefits by Medical Schemes, South Africa: A Focus on Breast and Cervical Cancer

Abstract

Breast and cervical cancers are among the top five worldwide. Over half of untreated breast cancer patients die, compared to nearly 90% of cervical cancer patients. Early breast and cervical cancer screening can reduce mortality risk. This study examined breast and cervical cancer rates among South African medical scheme members. The study’s secondary goal was to analyse how medical schemes funded these two cancers, including patient and/or out of pocket payments, to identify funding gaps. The study was a cross-sectional retrospective review of medical scheme claims data for oncology benefits, especially for breast and cervical cancers. The study used a multivariate logistic regression model to assess cancer rates. The results showed that the relative proportion of beneficiaries with breast cancer was higher in open schemes than restricted, in large schemes than medium and small schemes, in comprehensive plans, Efficiency Discount Options (EDOs), and hospital plans than in partial cover plans, and in age bands older than 55 in an out of hospital settings than in in-hospital settings. The paper advises examining the funding mechanism of oncology benefits to reduce Out of Pocket Payments (OOPs) for cancer patients, revising network arrangements, and using DSP as a barrier to access against uneven oncology provider distribution.