Medical expenses
  • Medical aids paid an average of R408 per visit to a general practitioner last year, new numbers show – as long as the consultation was not in a hospital.
  • The average pathology event cost roughly between R4,000 and R4,700, depending on whether it was out of hospital or in.
  • Here's what the Council for Medical Scheme's annual numbers show about the cost of average medical event, when medical aid is paying.
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In the last year, just about 5.5% of the benefits paid by medical schemes went to general practitioners, new data from the Council for Medical Schemes (CMS) shows. And on average, each GP “event” – typically equating to a visit – cost R408, as long as it did not occur in a hospital setting.

The CMS this week released its annual report, with numbers drawn from the accounts of both open and restricted medical aids in South Africa. That provides a view across R185.9 billion worth of healthcare expenditure for the year, with detailed breakdowns available across medical disciplines.

The overall numbers show increases in spending of between 5% and 8%; total healthcare expenditure by medical schemes was up 8% compared to the previous year, risk benefits paid per beneficiary were up 8.33%, and the average spend from medical savings accounts was up just over 5%.

The average costs recorded for medical events were

  • Out-of hospital visit to the GP: R408
  • GP in hospital: R1,037
  • Surgeons out of hospital: R1,369
  • Surgeons in hospital: R4,131
  • Anaesthesia out of hospital: R2,063
  • Anaesthesia in hospital: R3,667
  • Pathology out of hospital: R4,049
  • Pathology in hospital: R4,674
  • Radiology out of hospital: R1,475
  • Radiology in hospital: R2,109
  • Dentists out of hospital: R1,494
  • Dentists in hospital: R2,661

Specialists overall came in at R1,243 per event outside of hospitals, while in-hospital services cost an average of R1,621 each.

The numbers do not incorporate high – and rising – out-of-pocket expenditure by medical aid members recorded via their medical scheme.

(Compiled by Phillip de Wet)

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