Medical schemes are facing tremendous pressure in a low growth market where customer expectations and utilisation are very high and increasing, while loyalty is on the decline as a result of lower price tolerance. As the economy bites and more consumers opt to downgrade their cover to lower benefit options in a bid to cut costs, they are not realigning their ‘consumption-based’ expectations and are struggling to decipher the complexity of benefit options and scheme rules.
These are just some of the findings in the latest South African Customer Satisfaction Index for Medical Schemes (2019), conducted by Consulta, which provides highly scientific insights into the overall level of satisfaction of customers of South Africa’s medical scheme providers – Bonitas, Discovery, GEMS, Medihelp and Momentum. GEMS is the only closed medical scheme included in the survey. Consulta polled 1707 medical scheme members across five of the leading schemes by membership numbers.
According to Consulta, customers of all medical schemes polled in the 2019 Index indicated that they do not believe that the premiums paid match the quality of cover and experience on offer.
”Across the board, the industry is struggling to meet the needs of customers in terms of benefit design that meets the needs of customers in a simple and transparent manner. No outright leader was identified in this year’s index, with Bonitas and Discovery obtaining a joint leadership position, Medihelp coming in on par with the industry average (72.9) while Momentum is just below par and GEMS lagging in last place,” the Index revealed.
The SA-csi for Medical Schemes is the most comprehensive survey of customer satisfaction in South Africa, and is a causal model that links customer expectations, perceived quality, and perceived value to customer satisfaction (the SA-csi score), which in turn is linked to customer complaints (and recovery), and customer loyalty intentions.
One of the areas researched is the degree to which customers feel they are being treated fairly by their medical scheme, or Treating Customers Fairly (TCF) as it is referred to in the financial services industry. The medical schemes that came out tops were Medihelp (78.2) and Bonitas (78.9) – both above the industry average of 76.2. Discovery follows with 77.1 which is in line with the industry. GEMS (73.6) and Momentum (72.9) are lower than the rest of the industry.
The make-up of the overall TCF score looks at seven key aspects including:
| ● | Fair treatment of customers |
| ● | Products and services that address customer needs |
| ● | Transparent and easy to understand information |
| ● | Advice that is suitable for the customer’s circumstances |
| ● | Products and services delivered as expected |
| ● | It is easy for customers to claim, change providers, complain or consider other providers |
| ● | Customers are treated with respect and there is an open relationship |
Chairperson, the strongest predictors of satisfaction in the medical schemes sector is the degree to which customers feel that their healthcare cover provides peace of mind and their provider delivers as they were led to believe.
“Products need to be easy to understand and should not cause unnecessary effort to deal with. Staff members need to do their part by showing a high level of product understanding and empathy, taking ownership to resolve issues and providing customers with regular, relevant feedback during any process of interaction. It is very important that customers understand exactly what they are covered for during the sales and annual review process as this is where their expectations are born. The best way to achieve this is to drive simplicity in communication, remove jargon and provide sound advice that eliminates the chances of being disappointed at claims stage,” he concludes.
Professor Adré Schreuder’s conclusions are on par with the requirements of the FAIS Act, together with the principles of Treating Customers Fairly (TCF) – a framework for good business practice. With review time on hand, it is advisable to reconsider your client interaction. Do you simply forward the product provider’s notifications, or do you spell out material changes which will enable your client to make an informed decision, as you are legally obliged to do?
Click here to read more of the SA-csi findings as published on Consulta’s blog page.
