Good news for people with medical aid in South Africa

Due to the significant amount of money needed to implement National Healthcare Insurance (NHI) and the lack of a comprehensive funding model, medical aids are expected to stay around for a long time.

At a roundtable discussion, the Mail & Guardian reported that Mark Blecher, chief director of health and social development at the Treasury, said medical aids are not going anywhere soon. 

He explained that the Treasury cannot fund the NHI system alone, and private-sector healthcare will remain vital to support the country’s needs. 

“The possibility of the NHI squeezing out medical schemes is very unlikely for a very long time, if at all,” Blecher said. 

“It’s not easy to raise taxes, and the role of private financing is very important in our context. It’s difficult for the government to take on that private financing.”

“So we’re going to continue to see a role for private medical schemes and a multi-scheme arrangement for many years,” he added.

This message is not surprising given the slow and complicated process of implementing healthcare reforms that involve the private sector. 

While sections of the NHI Act and the Minister of Health have made it clear that the end goal is to limit the role of private healthcare, practical realities have pushed that future far into the distance.

According to section 33 of the NHI Act, once the NHI is “fully implemented,” medical schemes will no longer be allowed to cover services that the NHI pays for. 

However, the Act does not define “fully implemented,” what services the NHI will actually cover, or when this section will come into effect. 

These unknowns create significant uncertainty and effectively delay any real threat to medical aids’ role for the foreseeable future.

Despite this, Health Minister Aaron Motsoaledi has been firm about the government’s intention to eventually restrict medical aid schemes.

Health Minister Aaron Motsoaledi’s views on NHI

Speaking to Bhekisisa in 2024, he said that proposals to the government that do not involve changing the way healthcare is financed would be a “waste of time.”

Despite this stance, the vague wording of the Act, the lack of a clear timeline, and the government’s limited capacity to raise funds for the NHI mean that the status quo will likely remain for years to come.

When the NHI eventually comes into effect, medical aid will be limited to providing coverage only for services not funded by the NHI. For now, though, the NHI is still an abstract concept rather than an immediate reality.

Several experts have pointed to financial and practical challenges as significant barriers to rolling out the NHI. 

Profmed CEO Craig Comrie said the lack of any direct mention of the NHI during the most recent National Budget address highlights the extent of the obstacles ahead. 

“The absence of any direct mention of NHI in the speech is more telling than many South Africans realise,” he said. “It speaks volumes about the financial and practical roadblocks ahead.”

Comrie added that universal healthcare reforms must be built on feasibility rather than political promises. 

“Now more than ever, we need a pragmatic approach to healthcare reform that builds on the already-established healthcare assets rather than chasing an unrealistic, unbound, and unfunded ideal,” he said.

Given the uncertainty and the slow progress on the NHI, organisations like the Health Funders Association (HFA) have advised South Africans to maintain their private medical coverage.

Continuing with a medical aid plan remains the safest way to ensure reliable healthcare access for the foreseeable future.

This is because, while the NHI remains part of the government’s long-term vision, private medical schemes will continue to play a critical role in South Africa’s healthcare system.