<![CDATA[Purpose – Governance expenditure in medical schemes is funded from member contributions yet is routinely compared across schemes in rand terms, which reflects scale as much as conduct. This study estimates how each component of non-healthcare expenditure scales with scheme size and what size-adjusted benchmark follows. Method – An archival cross-sectional analysis of all 70 registered South African medical schemes, using Council for Medical Schemes annexures for 2024. Elasticities are estimated by log-log regression with heteroskedasticity-consistent standard errors; selection into positive reporting is modelled separately, functional form is tested, and predictions are retransformed with a smearing estimator. Findings – External audit fees (elasticity 0.39) and Principal Officer fees (0.48) are clearly sub-proportional, with confidence intervals excluding one, and trustee remuneration (0.78) marginally so. Staff, IT and legal costs have point estimates below one but intervals that include proportionality; administrator fees (0.92) are indistinguishable from proportional; and marketing (1.39) rises faster than membership. Composite internal governance cost scales at 0.84, but proportionality cannot be rejected for the aggregate. Reporting a positive amount is related to size on five of eight lines. Research implications – The size-adjusted benchmark is a screening device that identifies schemes warranting enquiry; it measures neither governance quality nor efficiency, and would require cross-year validation before supporting supervisory use. Originality – The study applies elasticity-based benchmarking to South African medical schemes and distinguishes cost behaviour across components within an explicit cost taxonomy.]]>
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