Gap claims related to cancer diagnoses dramatically increase in 2023; late diagnoses on the rise as preventative health checks remain deferred due to affordability challenges

An analysis of its gap claims related to cancer diagnosis and treatment by Sirago Underwriting Managers from 2020 to 2024 shows that the number of gap claims paid in 2023 relating to a cancer diagnosis or treatment, compared with 2020 (Pre-Covid 19) increased by 82%.

While Sirago points out that the correlation between Covid-19 and its cancer gap claims is not scientifically backed, it is still notable that during this specific period - the latter half of 2020 right into 2022 during the height of the pandemic – Sirago’s cancer-related gap claims plummeted, indicating the devastating impact that the pandemic had on preventative healthcare and early cancer diagnosis, as many people avoided going for health check-ups. Even with some return of normalcy, people continued to defer preventative care for months. The results of such deferment continue to manifest in 2023 and 2024 gap claims statistics related to cancer, which increased dramatically.

Sirago Underwriting Managers is a gap cover provider underwritten by GENRIC Insurance Company Limited.

Drilling down into Sirago’s claims statistics related specifically to cancer-related causes:

• Of the total number of Cancer-related gap claims Sirago paid between Feb 2021 to end Feb 2024:
  • 13% were paid in 2021
  • 11% were paid in 2022
  • 66% were paid in 2023
  • 7% have already been paid in 2024 (in just two months into year) – compare this with the year totals for 2021 - 2022.

• The percentage of cancer-related gap claims paid in each year, split by age group:

Martin Rimmer, CEO of Sirago, unpacks some of the key trends:

• Firstly, the pandemic aftermath and negative impact on preventative health checks is becoming very clear,  with almost 79% of all cancer-related claims in the time period from 2021 to 2024 occurring in 2023. Preventative healthcare and early diagnoses of chronic diseases, especially cancer, simply collapsed during the height of the pandemic in 2021/2022, and we’re still seeing that preventative healthcare is under pressure. By the time people returned to some semblance of healthcare check-ups in 2023, the number of later-stage cancer diagnoses – and gap claims - was marked.
• Going forward, we still expect that affordability challenges in the current environment will also play a big role as more people buy-down on their medical scheme benefits to core ‘hospital’ plans, and as a result preventative care is likely to take a back seat as these costs will need to be funded as out-of-pocket expenditure. Many people simply do not put a high value on the preventative benefits within their medical scheme options. It is definitely worth noting that early detection is far less debilitating, both from a recovery and financial perspective. Go and get your check-ups done, without fail, Rimmer suggests.
• Cancer is massively prevalent in our society and lifestyles, and certainly not a disease affecting only older generations. The implications for one’s healthcare funding and planning, from a younger age, is significant.  When you consider that almost 25% of all Sirago’s cancer-related gap claims are within the age group of 31-55 years, and over 60% is for ages between 31-70 – your most economically active and productive population – it paints a really concerning picture.
• Cancer is affecting more people, at younger ages – a trend that is highlighted by numerous research reports that show that the rates of more than a dozen cancers are increasing among adults under the age of 50. This rise varies from country to country and cancer to cancer, but models based on global data predict that the number of early-onset cancer cases will increase by around 30% between 2019 and 2030.¹ ²

Anecdotally, we see this trend reflected in Sirago’s ‘Initial Cancer Diagnosis’ claims - related to first-time diagnosis of malignant cancer - which saw a dramatic increase of 601% in 2021/2022 compared with 2019/2020, with more than half of these claims occurring in the under-55 age group.

“These trends are worrying in the sense that many of these cancer diagnoses are likely to be at much later stages of detection and this has a profound impact for patients in terms of the success and cost of their treatment. Furthermore, many consumers have been forced to buy down on their medical scheme benefits to ‘core-plans’, which in turn means access to potentially lower benefits and thus exposure to possibly more self-funding of their healthcare treatment to come from their own pockets if they do not have gap cover in place,” explains Rimmer.

“We’re seeing the evidence of this with a sharp uptick in ‘mega’ gap claims related to cancer - these are internally classified as claims of R50k and above for shortfalls or co-payments not paid by medical schemes.

Without having supplementary gap cover in place, many scheme members would have to fund these serious shortfalls not paid for by their medical schemes from their own pocket.  In fact, in a recent analysis of all our mega gap claims, we are seeing more frequently that gap cover is paying more than what the medical schemes are paying to doctors for in-hospital treatment as specialist doctor and hospital fees are now running levels that are many times more than the rate at which medical schemes reimburse.  This is particularly the case for medical scheme members who are on scheme benefit plans that only pay out at 100% or 200% of the tariff charged by medical specialists. These tend to be younger members who assume that because they are younger and healthier, they can make do with less benefits as they are less likely to claim – however when faced with a serious health crisis like cancer, which has no regard for age or state of health, this is moot,” adds Rimmer.

Surviving the healthcare financial challenges of a cancer diagnosis

All medical schemes typically cover the cost of Prescribed Minimum Benefits (PMBs) cancer treatments at cost, but this doesn’t automatically mean that all diagnosed cancers are necessarily a PMB. Each scheme has their own rules and protocols diagnosing and managing PMBs and if the cancer detected does not form part of the PMB basket, members will most certainly be exposed to out-of-pocket expenses during their treatment.

Certain medical schemes might also only fund certain treatments partially like biologicals, if at all.  Many core plans also do not fund any of the diagnostic tests such as MRI and PET scans either. If you’re not able to upgrade your medical scheme option to get the appropriate cover – either due to affordability or because the medical scheme has a waiting period on upgrades – you could be forced to sacrifice your life savings or future financial security to gain access to the treatment needed,” explains Rimmer.

There’s no telling when a serious health crisis may strike, and youth and health are no guarantee that you won’t face such a crisis in the prime of your productive life.  It’s crucial to meet with your independent financial planner to make sure that your healthcare funding plan such as medical scheme options and gap insurance work hand-in-glove to provide you with access to the best quality healthcare and treatment that you can afford. The importance of building a resilient healthcare plan that you can rely on during a health crisis like cancer has never been more critical,” concludes Martin.

For more information go to www.sirago.co.za

References: 

1. Global cancer phenomenon: It's not just America... the UK, Japan, South Africa and Australia are among dozens of countries suffering mystery spikes of all different kinds of tumors in young people. Located at: https://www.dailymail.co.uk/health/article-13197079/cancer-epidemic-young-people-america-uk-india-south-africa.html
2. Why are so many young people getting cancer? What the data say. Located at: https://www.nature.com/articles/d41586-024-00720-6#ref-CR1

-- ENDS --

Sirago Underwriting Managers (Pty) Ltd is an Authorised Financial Services Provider (FSP: 4710) underwritten by GENRIC Insurance Company Limited (FSP: 43638). GENRIC is an authorised Financial Services Provider and licensed non-life Insurer and a member of the Old Mutual Group.