Medical Aid Funding in South Africa 2022

South Africa has a two-tiered, and highly unequal, healthcare system, with most of the population being state-funded. While only 14.86% of the population can afford private healthcare sector, the high costs are making it increasingly difficult for some people to continue. Government plans to implement National Health Insurance (NHI) to fund healthcare in the public and private sectors, with most of the funding coming from general taxes and contributions of people earning above a set amount. The process, which began in August 2011, has been slow, and the NHI Bill is still under consideration in the National Assembly. The private sector has raised concerns about its affordability, and the state’s ability to implement it effectively and competently.

Key Issues

Rising and unregulated healthcare costs, an ageing population and the increase in non-communicable lifestyle diseases are key challenges. Average annual consumer prices for medical services and pharmaceuticals continue to increase ahead of inflation and premiums are high, making membership unaffordable for most South Africans. Fraud, waste, and abuse is a key issue in the industry, impacting around 22% of all claims. Fraudulent activity and abuse includes doctors and medical personnel colluding with members, submission of false claims, over-servicing or over-charging.

Trends

There has been a decrease in the number of registered medical schemes over the past two decades, mainly due to consolidation. Medical scheme membership, however, has increased. Claims declined in 2020 but increased in 2021 as members scheduled delayed elective surgeries. Changes are taking place in terms of attracting young members and low cost cover, online consultations and predictive and preventative care.

Report Coverage

This report on medical aid funding in South Africa includes information on the effects of the pandemic and recovery, membership and claims trends and the development of the NHI. There are profiles of 30 companies including the major government scheme GEMS and major private sector players such as Discovery, Momentum and Bonitas.