Discovery Health has been named the industry winner in the University of Pretoria’s inaugural Customer Experience Index (CE-Index®) for South Africa’s medical aid schemes, achieving the highest score across both the industry and product categories. As the largest medical scheme by membership, Discovery’s top ranking in the CE-Index® underscores its customer experience excellence,challenging the perception that larger providers struggle to deliver superior customer experiences.
The benchmark, which provides the country’s first scientificmeasurement of end-to-end customer experience in the medical aid sector, analyses the five largest schemes by market share – Bestmed, Bonitas, Discovery, Medihelp, and Momentum.
This year’s index also saw Discovery and Momentum share top honours in the Digital Channel category, while Discovery and Medihelptied in first place for Contact Centres.
Overall, the CE-Index®findingsshow a sector performing well on day-to-day service quality but lagging on perceived value and loyalty,largely due to product complexity and unresolved complaints.
Drawing on a sample of 3,179 comprehensive interviews, the medical aid industry achieved an overall CE-Index®score of 68.8 points out of 100, trailing the bankingindustry’s 73 points and life insurance’s75.3 points. Although schemes areoperationally efficient, the gap reflectsgrowing concerns around value, notes Professor Adré Schreuder, Head of the Industry Chair in Customer Experience at the University of Pretoria.
“The industry is delivering a competent service, and many touchpoints work well, as demonstrated by a reasonableQuality of Experience Index score of 74.9 points,” he explains. “But we see a gap between the Quality of Experienceand the Value of Experience score at 67.8 points. High-quality service means little if members don’t perceive real value.
“Value is about more than monthly contributions, extending to co-payments, the time it takes to get approvals or resolve an issue, and clarity about what’s covered. When plans are difficult to understand, perceived value suffers, and this was arecurring theme in the data.”
Pros and cons in problem resolution
In apositive for the industry, the Problem and Resolution Index measured82.6 points, a similar score to the life insurance and banking industries. Likewise, 52% of members felt that issues were “resolved to my expectations”,in line with international standards of 50% or more. However, 18% felt their issue remained “completely unresolved” – nearly double the global best-practice benchmark of 10% and lower.
“Almost one in five complaints went unresolved, which is one of the highest rates across the three industries we’ve measured,” says Schreuder.
“The complexity and lack of transparency around benefit rules, co-payments, network providers, and exclusions are playing a major role. Many members believe they’re covered, only to face a shortfall when they need to claim. That mismatch between expectation and reality drives dissatisfaction and undermines trust.”
Demonstrating the point, the Loyalty Index for medical aids stands at 68.6 pointsout of 100 – well belowthe 80points set by international benchmarks.The study also revealed a notable“action gap”when compared with other industries: only 40.5% of members qualified as promoters on the Net Promoter Score (NPS) measure – the lowest of the three sectorspublished to date.
Despite this relatively lower willingness to recommend, as many as24.3% of members said they had actually recommended their scheme. This equates to a behaviour-to-intention ratio of 60%, the highest across all industries measured, compared with32.8% in life insuranceand 41.8% in consumer banking.
This higher conversion rate suggests that emotionally chargedhealth experiences naturally spark credible, situational word-of-mouth, where real interactions outweigh planned intentions to recommend.
Ultimately, customer experience remains a key driver of loyalty. Satisfied members are more likely to stay with their current scheme, upgrade their cover, and recommend the brand. Medical aidstherefore stand to gain significantly from enhancing customer experience, particularly by simplifying plan information and improving the clarity and effectiveness of member communication.
Setting the scientific standard for customer experience
As scrutiny of industry awards and customer experience ranking increases, Professor Schreuder emphasises that the CE-Index®remains the only scientifically grounded and independently administered customer experience benchmark in South Africa. The index applies internationally recognised research design and stringent methodology, as well as comprehensive testing, to produce credible, comparable results across industries.
“Not all rankings actually measure customer experience. Additionally, many public polls and awards are self-completed or based on service impressions rather than statistically tested data from a representative sample, which can severely distort the results.
The CE-Index®is different – it measures the full customer experience, not just one touchpoint, and it applies strict statistical validation to ensure reliability and prediction ofsatisfaction and loyalty. It’s scientificallysound and transparent. Now, as a registered trademark of the University of Pretoria, we believe that it stands as the definitive national benchmark for customer experience.”
The creation of the index has created a meaningful opportunity for medical schemes to improve their customer experience and value proposition, gaining a competitive edge in a challenging market.
“The CE-Index®offers the industry a clear mirror that is grounded in real evidence. The challenge now is to act on those insights and close the value gap.”
Registered subscribers to the Index gain exclusive access to a comprehensive suite of insights through the CE-Index® Portal, including interactive dashboards, advanced segment filters, and detailed performance analytics.
SUPPLIED.
