Navigating the challenges and opportunities in South Africa’s private healthcare sector

Preventive healthcare is essential to improve health outcomes, lower long-term costs, and boost survival rates

The private healthcare sector in South Africa faces both significant challenges and opportunities. As the Health Funders Association (HFA), representing medical schemes and administrators covering 4.1 million lives, we believe the current focus on healthcare offers a unique chance for collaboration to build a sustainable system that ensures affordable and quality healthcare for all South Africans.

Medical inflation remains a critical concern, with schemes reporting increases well above CPI for 2025, adding pressure on affordability and access to care. Limited membership growth, coupled with an ageing and sicker population has driven the demand for healthcare services, with one in three members now managing a chronic illness – up from one in four in previous years. 

New innovative high-cost treatments such as biologics, which offer hope and relief to families facing life-threatening conditions – some costing more than R1 million per treatment – continue to place strain on finely balanced medical scheme budgets. To address these tensions, there must be a shift towards value-based care models, focusing on reimbursement for health outcomes and quality. Preventive healthcare, including wellness programmes, screenings, and early diagnoses, is essential to improve health outcomes, lower long-term costs, and boost survival rates.

There are also encouraging policy and industry developments. Renewed attention to Health Market Inquiry (HMI) recommendations and efforts to standardise coding structures promise improved efficiencies. Additionally, the introduction of Low-Cost Benefit Options (LCBOs) could expand access to private healthcare, potentially benefiting five million lower-income South Africans.

Recent changes to the HPCSA Ethical Rules mark a transformative moment, promoting multidisciplinary practices, fostering coordinated care and accelerating the transition from fee-for-service models to value-based contracting. These reforms align with efforts to improve patient outcomes through integrated care.

Artificial intelligence (AI) is emerging as a game changer, transforming healthcare by enhancing diagnostics, streamlining treatments, and enabling personalised care plans. For medical schemes and patients, AI supports tailored treatments, helping address skills shortages and improving access to care.

The future of private healthcare depends on collaboration among policymakers, providers, funders, patients, and innovators. Achieving Universal Health Coverage will require collective action to build a vibrant and sustainable healthcare system that serves all South Africans effectively.

Thoneshan Naidoo is Chief Executive Officer of the Health Funders Association (HFA)

Active Smart is the ultimate medical aid plan for the next generation of young professionals

Young professionals have unique expectations of healthcare. Over and above affordability, they prioritise personalised healthcare, unique digital experiences, benefits customised to their medical wants and needs, and lifestyle and wellness benefits.

While adults under 30 years old are less likely to need care for advanced illnesses, they are more likely to use emergency healthcare services. Research based on Discovery Health Medical Scheme claims found a 36% higher incidence of trauma events, such as accidental injuries, among young adults between the ages of 18 and 30, compared to other ages. Benefits for immediate access to high-quality healthcare in these potentially life-threatening events are paramount.

Young adults’ healthcare spending is primarily focused on their day-to-day needs. Discovery Health surveyed young adults in South Africa to determine which day-to-day benefits are most valued in a health plan. The results show that benefits for over-the-counter and prescription medicine are highly valued, followed by benefits for mental health, GP consultations, female health, dentistry, and optometry.

In January 2025, the Smart Series of the Discovery Health Medical Scheme will be expanded to include a new, more affordable medical aid plan designed for young professionals. The new Active Smart plan is the most affordable plan in the open medical scheme market, considering its benefits. It prioritises flexible benefits for day-to-day healthcare and immediate cover for emergency care in hospitals, in line with their wants and needs.

At only R1 350 per month, Active Smart provides a compelling medical aid option for young professionals.