Top 10 Discovery medical claims paid in 2024 totalled R70m
The second highest claim was for 'major surgical procedures' in a newborn at R8.4m. Picture: Shutterstock
Discovery Health Medical Scheme (DHMS) says 10 of the highest member claims paid in 2024 totalled R70.5 million.
The highest, per its disclosure in a presentation at the scheme's AGM on Tuesday, was for a 75-year-old member who was paid out R9.6 million for 'care for [the] long-term use of a ventilator'. To fund this claim, it would take a theoretical 283 years' worth of contributions (nearly 3 400 months).
Half of the top 10 claims were for the long-term use of a ventilator, with the youngest patient being a new-born (the second youngest was 16).
There were two new-borns in the top 10 list.
It says across the top 10 claims, 98% of the costs were covered by the scheme.
Read more Parliament allocates R71m for medical aid for former MPs
DHMS says 2 108 individuals claimed in excess of R1 million in the year.
It paid a total of R45 billion in hospital claims last year, with a total of 714 000 hospital admissions. Of these, 35 000 of its members and beneficiaries were admitted to ICU.
In total, it paid R83 billion in claims expenditure in 2024.
A third (32%) was day-to-day, 4% was for chronic medication, 2% for maternity-related claims and 8% for oncology (nearly R7 billion).
Scheme members made 2.3 million specialist visits in 2024, with 10.6 million dispensaries of over-the-counter and 14.2 million of prescribed medication.
There were 28 000 babies born, 121 000 mammograms and 209 000 prostate checks conducted, and 435 000 health checks done across its members.
ALSO READ: More than half of Discovery's medical aid plans saw declines in members last year
Incentivising the prioritisation of health
It incentivises the health checks through Vitality, which from this year has launched a far more personalised programme using Personal Health Pathways.
Because this is unique to each member and dynamic, Discovery says there are more than seven million possible personal health pathways per member, across its base of 2.1 million members. Across its eligible member base, 13% have activated personal health pathways (the programme is not mandatory).
In terms of so-called 'next best actions', 270 000 health actions had been completed by mid-June, with getting a flu vaccine being the top one.
More than 1.1 million exercise actions had been completed, but these tend to be weekly challenges (either closing an exercise ring or walking more than a certain number of steps).
More than a third of all actions had been completed by members with what Discovery calls 'emerging health risk'.
This is precisely the point of personal health pathways – to make members healthier by getting them into shape to avoid chronic illnesses, or to get them to actively manage those chronic conditions actively.
Completing actions offers rewards for members, either in the form of benefits in a personal health fund or Discovery Miles. The fund can be used for day-to-day benefits as a 'booster' to cover on a member's medical aid plan. So far (to mid-June), members had accumulated R137 million in their personal health funds, with nearly half of this used for pharmacy visits.
ALSO READ: Sanlam pays out R6.62 billion in death and disease claims
Chronic conditions and complexities
DHMS says that of those with chronic conditions, 51% have one, 22% have two, 15% three and 12% four.
The overlap between chronic conditions such as cardiovascular, diabetes, oncology, and mental health 'leads to increasingly complex care needs'.
A member with a chronic and mental health condition is 3.5 times more at risk of admission than one with no chronic condition.
It has a number of care programmes for these conditions, the largest of which is cardio care (216 000 members), followed by oncology (101 000) and HIV (82 000). In total, more than one million members benefit from these tailored programmes.
ALSO READ: Increasing medical aid scheme costs: What are the alternatives?
Trustees
The election of trustees for DHMS, which saw aggressive lobbying by various parties given that there were three vacant spots, was completed at the AGM.
There were 77 candidates vying for these positions.
Joan Adams, David Charles King and Dr Max Price were elected as trustees of the scheme. Adams and Price were re-elected as they had only served a single term as trustee. The other member whose term had come to an end, Marius du Toit, was not re-elected.
The scheme's board of trustees must comprise at least five and at most eight members. DHMS has seven trustees.
This article was republished from Moneyweb. Read the original here.
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Top 10 Discovery medical claims paid in 2024 totalled R70m
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