<![CDATA[Purpose – Marketing is a material discretionary cost for medical schemes, yet almost two-thirds is classified under International Financial Reporting Standard (IFRS) 17 as expenditure not attributable to an insurance portfolio. This study examined its scale, distribution and attribution status and tested its association with membership growth. Method – An archival observational analysis combined a 2024 cross-section of all 70 registered South African medical schemes, a matched lagged specification for 2023–2024 and a sector-level trend for 2019–2024. Associations were assessed using Pearson and Spearman correlations with 95% confidence intervals and ordinary least squares regression. Findings – Marketing expenditure totalled R1.286 billion; 63.2% was non-directly attributable. Reporting varied substantially: 32 of 36 spending schemes assigned the entire marketing line to one category, while non-directly attributable shares among the largest spenders ranged from 0% to 100%. The five largest spenders accounted for 74.8% of expenditure, and open schemes were approximately twice as marketing-intensive as restricted schemes. No statistically significant association emerged between marketing intensity and membership growth. Research Implications – All 95% confidence intervals included zero and were wide, allowing both modest associations and no association. Marketing intensity was highly persistent between 2023 and 2024 (r = +0.98), including among spenders and within each scheme type. Statutory returns should include an activity dimension alongside accounting classification. Originality – The study reframes marketing as a discretionary cost-attribution problem and documents limited activity-level visibility in statutory reporting. Whether heterogeneity reflects differences in marketing activities or accounting judgement remains unresolved.]]>
