Perceived Knowledge of Scheme Members and Their Satisfaction with Their Medical Schemes: A Cross-Sectional Study in South Africa.

Abstract

Background: South Africa has a dual healthcare system comprised of private and public sectors covering 16% and 84% of the population, respectively. Medical schemes are the primary source of health insurance in the private sector. The aim of this study was to assess the perceived knowledge and satisfaction of open medical schemes members. Methods: A cross-sectional survey was conducted using a stratified systematic sample of members from 22 open medical schemes. Nine hundred and sixty members were requested to complete an online semi-structured questionnaire to determine their perceived knowledge and satisfaction with their schemes. We tested to see if variables such as age, gender, years of membership, education, income or having a chronic disease were associated with better-perceived knowledge or satisfaction. We calculated a composite perceived knowledge and satisfaction score, for which a score above 60th percentile for perceived knowledge and 60th for perceived satisfaction were considered good perceived knowledge and good perceived satisfaction with their schemes.Results: Respondents, generally perceived themselves to have good knowledge and were satisfied with their schemes except for accessibility to doctors under the designated service providers arrangement. Overall, members were satisfied, especially with the quality of service from their designated service providers (DSPs) and their schemes. However, only 9% were satisfied with accessibility to doctors under their DSP arrangement, 25% were satisfied with the cost of scheme membership and only 46% were satisfied with the prescribed minimum benefit package. The test for association showed that years of medical schemes membership, perceived knowledge of the prescribed minimum benefits, better income and laying a complaint were associated with better-perceived knowledge. Conclusion: Medical schemes remain a key element of private healthcare in South Africa. The analysis shows that medical schemes, should put more effort into the accessibility of general practitioner under their designated service providers. Furthermore, the PMBS should be reviewed to provide a comprehensive benefits basket without co-payment for members as recommended by the Medical Schemes Act Amendment Bill of 2018.