COVER FEATURE: POLMED
Which key strategies have fuelled POLMED’ s performance and growth? Our success is the collective achievement of our Board, employees, and service providers. Our strategy is anchored in three pillars: scheme sustainability; accessible, quality healthcare; and strong stakeholder relationships.
These are executed through:
• Member centricity and delivering accessible, evidence-based healthcare.
• Benefit design optimisation to meet our members’ clinical risk profile.
• Preventive and proactive care, reducing long-term disease burden.
• Zero tolerance for Fraud, Waste and Abuse, supported by advanced analytics.
• Enterprise risk management and financial discipline.
• Financial discipline, prudent risk management, and preserving member funds via a healthy solvency ratio.
• Operational efficiency through vertical integration and cost control.
This aligns with our long-term vision: Healthy members for a safer South Africa.
In a competitive market, how are you differentiating through innovation, value creation, and service excellence? As a restricted medical scheme for the SAPS, we tailor benefits to our members’ specific clinical risk profile, as mentioned before. Our differentiation is driven by:
• Evidence-based cost-effective benefits that exceed Prescribed Minimum Benefits( PMBs), especially in preventative and mental health care.
• Comprehensive preventative and mental health benefits extending beyond PMB requirements.
• Nationwide provider coverage with no member copayments, ensuring accessible quality care.
• A younger-than-industry-average membership profile, which helps maintain affordability.
• Digital innovation like the POLMED Connect App, which provides members with seamless access to services.
Innovation is central to our service model. We have embarked on a comprehensive digitalisation journey, including the July 2025 rollout of our POLMED Connect App, which gives members seamless access to Scheme administration, benefit information, and clinical support directly from their mobile devices.
How do you balance affordability with highquality healthcare? We apply a multi-layered cost-containment strategy that balances financial sustainability with uncompromised quality of care.
Key measures include:
• Strengthened managed-care protocols, ensuring care is delivered at the right level and avoiding unnecessary interventions.
• Enhanced Fraud, Waste and Abuse controls, supported by data analytics and clinical oversight.
• Strict control of non-healthcare administration costs, ensuring operational efficiency.
• A prudent investment strategy, protecting and growing Scheme reserves.
This financial strength has allowed POLMED to implement muted contribution increases for 2024 through to 2026, a key achievement in the current climate.
This transformation will elevate member experience, improve cost efficiency, and position POLMED for a digital-first future.”
With over 25 years in healthcare, what are the major industry shifts you’ ve witnessed? The landscape has consolidated due to stricter solvency rules and regulations, and rising costs. Surviving schemes are larger and, unfortunately, ageing. The evolution of PMBs claims practices, governance standards, and healthcare inflation increased pressures, and was compounded by Covid-19 volatility.
The medical scheme industry had two major investigations, the Healthcare Market Inquiry and the Section 59 Investigation, both of which have made significant findings on threats to the sustainability of the sector. These include high regulation on
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