These were the biggest hospital claims Discovery paid last year

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On average for every R100 Discovery paid for a claim relating to a hospital admission, R62.70 is paid to the hospital and R17.80 to specialists.(Getty Images)
  • A new Discovery report shows that the costliest hospital visits involve heart bypass surgery and the long-term use of a ventilator.
  • The report also shows that almost 60% of Vitality members are overweight, while more than 30% of members have unhealthy cholesterol levels.
  • The 2.8 million Discovery medical scheme members visited specialists 2.2 million times in the past year.

Discovery Health Medical Scheme (DHMS) released a new report that tracked member claims over the year to end-September last year.

The scheme covers 2.8 million people – almost a third of all medical scheme members in South Africa.

More than 671,000 hospital stays, at an average cost of R43,057 per admission and an average duration of three and a half days, were covered.

The biggest hospital bill – of R5.5 million - was for a 68-year old who stayed in hospital for 182 days due to unidentified infections.

Top 10 hospital claims


The hospital claims show that major medical treatments can be required at any age, Discovery said in the report.

The most expensive hospital procedures are: 

  • Long-term use of a ventilator: R1,145,158 (average cost)
  • Heart bypass surgery and heart catheterisation: R497,049
  • Heart bypass surgery: R425 318
  • Surgical procedures to fuse the spine: R201,146

On average for every R100 paid by DHMS for a claim relating to a hospital admission, R62.70 is paid to the hospital and R17.80 to specialists. The rest of the money goes towards pathology, radiology and ambulance transport.

Chronic conditions

The report also included the average results of Vitality screenings.

It shows that almost 60% of Vitality members are overweight (according to ‘waist-adjusted’ BMI tests), while more than 30% of members have unhealthy cholesterol levels.

Vitality results
Vitality results

This is reflected in the number of members with chronic condition such as diabetes or high blood pressure, which has more than doubled since 2008, Discovery said.

The most common chronic condition for the period was essential hypertension, with 376,341 members suffering from the condition. Hypothyroidism saw the greatest increase - of more than 12% from the previous period.

Top 10 chronic conditions


Doctor visits

The 2.8 million members were responsible for 6.8 million GP visits, with 2.2 million visits to specialists. DHMS also reports that there were 4.3 million visits to “allied” professionals, including biokineticists and physiotherapists. Some 24.8 million scripts - almost nine per member - were dispensed.

In total, DHMS paid R21.4 billion in day-to-day claims – which according to a Netwerk24 report, was 22% higher than the year to March 2018.

Cancer cases

Some 36,783 members received oncology treatments – a number that has almost doubled since 2010, while membership only increased by 24% in the same time.

Breast cancer is the most common cancer, followed by prostate, colorectal and malignant melanoma.

Top 10 types of cancer

Source: Discovery

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