Ina Opperman

By Ina Opperman

Business Journalist

Is primary healthcare insurance a good idea if medical aid is too expensive?

Millions of people who live on a tight budget simply do not have the money to seek medical treatment for healthcare issues.

Primary healthcare insurance could be a good idea if medical aid is too expensive for you as it gives you access to private healthcare advice and treatment, helping you to avoid depending on state healthcare.

“The increase in primary health care insurance products in South Africa fills a significant gap in the market and helps to improve the quality of life for millions of South Africans who cannot afford medical aid membership,” Michael Emery, marketing executive for Unity Health, a division of Ambledown Financial Services, says.

“Approximately only 16.1 % of South Africans have access to private healthcare. This number may decrease, considering the state of the South African economy, the soaring cost of living and the escalating cost of medical aid, which now costs an average of R2 104 per beneficiary per month, according to the Council for Medical Schemes.”

Emery says this results in many people having to borrow money from friends and family to pay for treatment, or worse by trying to use home remedies or simply bearing the pain until payday. This does not only affect their quality of life, but delayed treatment can increase the seriousness of the ailment.

ALSO READ: Can’t afford medical scheme membership? Here are some alternative options

Access to primary healthcare

“Primary healthcare plans are designed to give people access to essential private healthcare advice and treatment, such as basic and emergency dentistry, optometry and general practitioners. Primary health cover is an affordable medical insurance product designed to cover primary consultations.”

However, Emery points out that these products are not part of a medical scheme and the cover, benefits and contributions are not the same as those for a medical scheme. 

“These plans can also support improved wellness by covering vaccinations and critical health screenings, such as prostate cancer screenings and pap smears, which cash-constrained South Africans might neglect due to affordability.”

Cervical cancer is the second most common cancer among South African women, yet some research found that only around 18% of rural women ever had a pap smear. The lifetime risk for prostate cancer in South African men is one in 15, yet many men do not get screened until they already have symptoms.

Emery says by making screenings affordable and accessible, primary healthcare cover gives more South Africans access to early detection and treatment of common cancers.

“Without this cover, many people would otherwise go to government facilities where they might wait for days to be seen, or they might possibly not seek treatment at all. This primary care option makes preventative healthcare more accessible.”

He emphasises that primary health insurance does not cover private hospitalisation for non-emergencies or elective procedures. “Consumers who want to get cover for private hospitalisation must investigate the different options and take out a separate hospital plan.

ALSO READ: How to make the most of your medical aid scheme

Not suitable for chronic illness cover

“Primary health insurance products are also not ideal for consumers who want cover for healthcare needs such as chronic conditions or oncology.”

However, consumers who are generally healthy but need the peace of mind that they have access to GP visits, primary healthcare insurance is the ideal, affordable solution. “Speak to your broker, who can help you choose the best solution for your needs.”

According to the Worlds Health Organisation (WHO), primary healthcare has been shown to meet most of a person’s health needs throughout their life. The organisation also says around 90% of essential health services can be delivered through primary care.

“Many consumers are feeling the need to tighten their belts to survive some really tough economic times. Fortunately, there are alternatives to consider when it comes to protecting your health. Private healthcare professionals are essential to provide timely treatment and therefore people must be empowered with affordable access to private primary care where they can get the treatment they need,” Emery says.

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