The cost of being sick in South Africa

Finding affordable healthcare in South Africa is possible, but it comes with challenges. Patients often wait for hours to be assisted, and fatigued doctors sometimes miss underlying conditions.

For many, however, the cost of a private practitioner can be prohibitive. We contacted 12 Cape-based doctors to ascertain private GP fees, and we found out how medical schemes assist with these. Finally, we compare South Africa with other emerging economies.

Private vs public healthcare

Vaughn Harrison, a partner at Hogan Lovells law firm says, “Private healthcare is generally regarded as being good, while public healthcare is regarded as being in decline, even though the majority of citizens rely on this service.”

This, he says, is despite the high percentage of funding that’s allocated to the sector.

On average, South Africans can expect to pay R514 for a private GP visit.

The pricing below is based on information obtained from one practice in each area.

How can medical schemes assist with these costs?

Medical schemes provide a blanket of protection during routine- and emergency health events. Depending on the kind of cover chosen, medical expenses covered include, for example, doctor’s visits, nursing, surgery, dental work, optometry, medicine and hospital accommodation when needed, says Council of Medical Schemes (CMS).

According to the council , South Africans can choose from among approximately 760 medical schemes. As of 2021, approximately 14% of the South African population belonged to a scheme.  

“South African medical schemes are especially unique, in that they cover Prescribed Minimum Benefit (PMB) conditions,” says the CMS. “These are a set of defined benefits to ensure that all medical scheme members and beneficiaries have access to certain minimum health services, regardless of the benefit option they have chosen.”

PMBs include:

• Any emergency medical condition
• A limited set of 271 medical conditions (defined in the Diagnosis Treatment Pairs); and
• 26 Chronic conditions (defined in the Chronic Disease List)

Medical schemes are expensive and imperfect

According to the CMS, the average gross contribution towards medical aid per beneficiary per month is R2,053.48, and client complaints are frequent. The following are the main issues raised, according to the CMS.

• Application of co-payments and insufficiency of benefits
• Non-payment and short payment of claims (PMB- and non-PMB related)
• Exclusion of certain treatments from funding
• Imposition of general and condition-specific waiting periods
• Termination of membership due to non-disclosure of material information

“While some medical plans misapply the Act and Regulations by incorrectly limiting funding for PMB conditions, most members are not aware of their benefit offerings and financing limitations,” says the CMS.

 Additionally, it appears there is little to no understanding of the rules that govern their medical scheme.

South African healthcare compared to BRICS

A 2016 study conducted by Harrison indicated that South Africa held up very well in comparison to its peers in the BRICS (Brazil, Russia, India, China, and South Africa) collection of emerging economies. At that time, South Africa was outperforming its counterparts in terms of healthcare, and in adherence to the healthcare parameters. If anything, more citizens were spending money on medical schemes than in other BRICS countries.

What does the future hold?

The National Health Insurance (NHI), potentially.

“The government has announced its intention to provide health care to all. This will be a big task, and one that needs careful management, as it will be costly. Also, no estimates regarding the costs of introducing the NHI have been furnished to date,” says Harrison.

“The NDoH must tread carefully when introducing the NHI, so as not to disrupt the private healthcare sector and the various professionals engaged therein, such as doctors, dentists, and nurses,” he says.

Once implemented, the NHI will extend decent medical cover to all South Africans. It will diminish the long queues and spread the healthcare burden across all sectors, ensuring all citizens have access to the assistance they need.

To improve the country’s health, South African taxpayers can expect their funds to be allocated towards the NHI.

“While it is frequently stated that the only certainties in life are death and taxes, it can also be said that the costs of extending medical care to all, and attempts to make this affordable, will continue to tax South Africans,” says Harrison.

He explains that issues of medical costs and coverage is a vexing one for all societies. Even in larger economies, like America, affordable care, as it is known, is not universal, and high medical costs remain a challenge.