While size does matter, it is short-sighted to assert that only large schemes have an enhanced ability to negotiate better costs with hospitals, set up wider networks for their members and boast superior buying power in all other areas. The GTC report thus excludes a number of factors that can effectively ensure that medium sized schemes enjoy the same, and in some instances enhanced, benefits when compared to their larger counterparts:

 

  • Individual employer group needs and the specific membership demographic profile in medium sized schemes enjoy far greater consideration and influence in the benefit design of their respective schemes, a factor often lost when dealing with larger players who need to deal with large numbers and less customised products.
  • In mid-tier schemes, employers and members are not viewed simply as numbers, but have a real impact on scheme policy and processes.
  • In the current environment, Prescribed Minimum Benefits (PMBs) have near standardised the benefit offering across all schemes, a scenario that has also ensured a more equal spread of risk across a scheme’s entire membership base. This means that scheme size cannot be regarded as a key competitive advantage and further highlights the role of the advisor in determining the best option for their client’s needs without being influenced simply by scheme size and membership.
  • As part of the Agility model, negotiations with providers is done very effectively by pooling scheme requirements into a single entity, hence achieving the same, or in some instances better, provider tariffs for our client schemes than big schemes would on their own.

 

The GTC Survey also doesn’t take into account the integral role of adequate technology in the risk management and provider contracting equation. Agility, for example, deploys the industry’s only end-to-end integrated administration and risk management technology, thus ensuring the proper execution of effective risk management principles and contents of provider contracts. Of particular concern is that this area is typically lacking in so-called large medical schemes.