Everything you need to know about medical aid schemes in South Africa

Stats SA has released the results of its latest General Household Survey, revealing how South African families make use of medical aid schemes in the country.

According to the report, the vast majority of people are not covered by any type of medical aid scheme, with public facilities still being the primary choice when it comes to healthcare.

One of the biggest barriers to private healthcare in the country is the price.

The South African Competition Commission recently conducted a market inquiry into medical aid schemes, focusing on the price of services and costs involved with private healthcare in the country.

The inquiry was triggered by data that showed that per capita spending on services such as hospitals and medical specialists in SA increased in real terms by 40.7% and 55.7% between 2003 and 2012 – while expenditure on all health benefits by medical schemes rose by 11.1% in 2014 to reach R124.1 billion.

The cost of private healthcare is increasing significantly, with little to no oversight or regulation to keep tabs on what’s pushing the effect, the Commission found.

According to the Medical Aid Council of South Africa, hospital fees account for the biggest portion of what medical aid schemes pay for, taking up to 40% of total fees paid out, with specialists and medication taking up the rest.

These costs paint the backdrop for Stats SA’s findings, explaining why private healthcare is out of reach for so many.

Here are other facts about medical aids and healthcare in South Africa:

  • 70.5% of the population choose a public hospital or a public clinic as their first point of contact when it comes to health issues in the country – 27.7% of the population choose private healthcare.
  • Only 0.4% of the population go to a traditional healer as their first choice.
  • Private healthcare users are overwhelmingly positive about their experiences, with 92% of people indicating they are very satisfied with the care they receive. This, compared to only 57.5% of very satisfied public healthcare users.
  • Only 17.5% of South Africans are covered by medical aid. Between 2002 and 2015, individuals who were covered by a medical aid scheme increased from 7.3 million to 9.5 million persons.
  • 44.6 million people are not covered by medical aid.
  • The majority of white people in South Africa are covered by medical aid, with 73.3% of all whites being subscribed. The Indian/Asian population covered by medical aid is approaching half (44.5%).
  • The black African population and the coloured population are least covered at 10.6% and 19.3%, respectively.
  • Gauteng has the most medical aid members, with 27.7% of the province covered. This is followed by the Western Cape (24.2%). Limpopo is the province with the lowest membership (8.5%). Understandably, medical aid membership is concentrated around metropolitan areas.
  • City of Tshwane has the most medical aid subscribers across SA metros, where 33% of individuals are members. This is followed by City of Cape Town (28%) and Ekurhuleni (27.9%). Ethekwini has the lowest number of medical aid members at 19.2%.

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Everything you need to know about medical aid schemes in South Africa