Despite a year defined by economic turbulence, regulatory uncertainty and ongoing pressure on household disposable income - both globally and locally - Bestmed Medical Scheme has once again demonstrated resilience and stability, achieving robust financial performance in 2024 and marking its 60^th anniversary with distinction.

The South African medical schemes industry continues to face substantial strain, not only from an industry growth perspective, but also from a sharp rise in healthcare costs and a surge in more complex, expensive medical cases. Nonetheless, Bestmed has remained steadfast in its commitment to members, recording a net membership growth of 4.4% (2023: 4.8%) - its sixth consecutive year of growth - while maintaining strong solvency and a healthy balance sheet.

“Bestmed's strategic priorities for 2024 centred on sustainable membership growth, operational excellence, leadership and innovation in healthcare, as well as delivering value for money to members,” said Leo Dlamini, CEO and Principal Officer at Bestmed Medical Scheme. “2024 was not an easy year for industry role players.  Economic uncertainties, ongoing regulatory changes and real pressure on household budgets created a tough operating environment.”

“We're also seeing the impact of more sophisticated treatments, higher-cost medications and members presenting with increasingly complicated health conditions that specialised care. These factors are not short-term challenges; they’re part of a longer-term shift that will continue to affect medical schemes and their members. In this context, I am pleased with our performance and the proactive steps we’ve taken - not only to enhance service delivery and remain competitive, but to continue providing value and a personal, member-centric approach that is so vital in today’s business environment.”

Key highlights from the 2024 financial year include:

• Solvency ratio: 33.23% (2023: 36,89%), well above the 25% statutory requirement
• Total assets: R5.4 billion (2023: R4.9 billion)
• Insurance revenue: R7.2 billion (2023: R6.5 billion)
• Amounts attributable to future members (previously net surplus):  R164.4 million (2023: R38.7 million)
• Risk contribution income: up 11.76%
• Return on assets on investment at 11.2% (2023: 8.7%)

In terms of claims ratio, the consistent high levels at 94.42% (2023: 95.58%), reflects the ongoing reality that members are back to using healthcare services fully post COVID. Bestmed is seeing a full return to elective surgeries, routine check-ups and specialist care post-pandemic - alongside a rise in complex cases and cancer diagnoses that demand intensive and high-cost treatment.

“The 9.6% weighted average contribution increase for 2024 was driven by higher claims and the need to maintain adequate solvency,” added Dlamini. “In 2021 and 2022, we deliberately kept our contribution increases low – at 4.0% and 3.9%, respectively - well below medical inflation at the time, but as claims normalised and healthcare costs increased, we needed to adjust to ensure we can pay claims and remain financially sustainable in the long-term. In 2024, we paid out R6.5 billion in healthcare claims - real healthcare benefits delivered to members.”

With regard to claims payments, hospitalisations continue to have the largest share at 47% - up slightly from previous years. Specialists’ claims remain steady at 19% - consistent with the past three years. Medicines claims dropped slightly to 9% from 10% in 2023, while general practitioners, pathology and other claims categories have remained stable at 2%, 7% and 16%, respectively.

“What's encouraging is that these trends are relatively stable,” added Dlamini.

While the medical scheme industry continues to confront increased fraud, waste and abuse challenges including false claims and code farming, Bestmed actively continues to investigate all suspicious cases and is exploring AI integration to analyse claims data rapidly and manage irregularities. “We have a fiduciary duty to our members to manage their contributions with integrity and transparency, and to ensure those funds are used responsibly to pay for genuine healthcare services,” said Dlamini.

In 2024, Bestmed was also honoured with accolades, including News24 Medical Scheme of the Year and ranking second in customer experience in the Ask Afrika Orange Index® Medical Aid Companies category.

“For the year ahead, we have a number of key focuses, including prioritising competitive benefit options, ensuring contributions remain market aligned, as well as strengthening our service excellence, human resources and IT infrastructure,” added Dlamini. “In addition, we remain committed to navigating the uncertainty surrounding the implementation of National Health Insurance (NHI).

“As we move into our next chapter, we remain focused on safeguarding the future of the Scheme and ensuring sustainable value for our members and partners. Our mission continues to remain rooted in our Personally Yours promise - putting people first in every decision we make.”