Trouble for private healthcare in South Africa – and it’s not just the NHI
Despite an increase in the number of individuals with private medical aid, the proportion of South Africans covered by it has not grown over the past two decades and has even decreased over the past decade.
With medical aids covering an estimated 15.7% of South Africa’s population (~9.79 million people), public healthcare options remain the first point of reference for an overwhelming majority of South Africans.
This was outlined in StatsSA’s recent 2023 General Household Survey (GHS), which looks at various aspects of South Africans living conditions, including their access to basic services, education, health, employment, income, and food, among others.
These healthcare figures by StatsSA are expected to change significantly over the next decade or so due to the recent signing of the National Health Insurance (NHI) into law.
Section 33 of the NHI states that once NHI is ‘fully implemented’ medical schemes will be able to cover only those services that are not covered by NHI.
This implies that medical scheme cover will be replaced by the NHI at that point in time.
Current go-to healthcare facilities for South Africans
“The type of healthcare facility consulted by household members are influenced by factors such as households’ proximity to facilities as well as personal preferences based on factors such as affordability and the perceived quality of services,” said StatsSA.
Nationally, 73.1% of households said that they would first go to public clinics, hospitals or other public institutions for their healthcare needs.
Accordingly, 25.4% of households said that they would first consult a private doctor, private clinic or hospital.
Looking at the provincial breakdowns of the percentage of households first consulting public healthcare facilities are:
- Limpopo – 83.6%;
- Eastern Cape – 81.2%;
- Mpumalanga – 79.9%;
- KwaZulu-Natal – 79.4%;
- North West – 78.5%;
- Northern Cape – 73.5%;
- Free State – 73%;
- Gauteng – 66.7%;
- Western Cape – 57.5%.
Medical aid
Between 2002 and 2023, despite minor fluctuations, the proportion of individuals enrolled in a medical aid scheme experienced a minimal reduction, decreasing from 15.9% to 15.7%.
This is down from 17.7% recorded in 2010 and 2014.
Over this period, along with the population, the count of people enrolled in a private medical aid scheme rose from 7.3 million to 9.8 million.
Looking at the provincial breakdowns, medical aid coverage among individuals is the most common in the Western Cape and Gauteng, at 25.7% and 22.4%, respectively.
This is contrasted with Limpopo and Mpumalanga, which sit at 9.5% and 9.8%, respectively.
Metropolitan areas record considerably higher percentages of their populations on medical aid, compared to provincial and national averages, at 23.5%.
Looking at the breakdown, the percentage distribution of individuals who are members of medical aid schemes by metropolitans are:
- Tshwane – 30%;
- Cape Town – 27.8%;
- Ekurhuleni – 22.4%;
- Nelson Mandela Bay – 21.3%;
- eThekwini – 21.2%;
- Buffalo City – 20.9%;
- Johannesburg – 19.8%;
- Mangaung – 18.7%.
Looking at population groupings, 71.7% of white individuals were members of a medical aid scheme compared to 41.3% of Indian/Asian individuals, 19.6% of coloureds and 9.8% of black Africans.
However, expressed as a share of all medical aid members in the country, it is made up of:
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