Funding of Oncology Benefits by Medical Schemes, South Africa: A Focus on Breast and Cervical Cancer

Breast and cervical cancers are among the top five worldwide. The mortality rate for breast cancer is over 50%, when compared to cervical cancer, which is nearly 90%. Early breast and cervical cancer screening can reduce mortality risk. This study examined breast and cervical cancer rates among South African medical scheme members. The study's secondary goal was to analyse how medical schemes funded these two cancers, including patient and/or out-of-pocket payments, to identify funding gaps. The study was a cross-sectional retrospective review of medical scheme claims data for oncology benefits, especially for breast and cervical cancers. The study used a multivariate logistic regression model to assess cancer rates. The results showed that the relative proportion of beneficiaries with breast cancer was higher in open schemes than restricted, in large schemes than medium and small schemes, in comprehensive plans, efficiency discount options (EDOs), hospital plans than in partial cover plans, in age groups older than 55, in an out-of-hospital setting than in in-hospital setting. The paper advises examining the funding mechanism of oncology benefits to reduce out-of-pocket payments (OOPs) for cancer patients, revising network arrangements, and using designated service provider (DSP) as a barrier to access against uneven oncology provider distribution.