The Key to Healthcare Access in South Africa

South Africa has, in effect, two healthcare systems: public and private. Here's why access to private offerings is so important – and how Medical Aid helps you get there.

South Africa ranks first in the world for platinum exports, 35th in the world for press freedom, and third in the world for Test match cricket. But what about the rankings that matter most to you and your family... like healthcare?

In a 2020 Global Healthcare Index report, published by the crowdsourced Numbeo database, Taiwan, South Korea and Japan ranked as the countries with the top three healthcare systems in the world. South Africa came 49th out of 89 countries.

That's not bad, but not great either. Solid mid-table finish. Our status was hindered by factors like our two-stream public vs private system, the fact that healthcare accessibility remains poor in rural areas, and our public system's inability to retain physicians.

Dr Ayanda Mbuli, General Manager: Health Policy & Clinical Advisory Unit at AfroCentric Group, says that ranking the "best healthcare system", much like most things in life, is usually in the eye of the beholder.

However, there are a couple of factors that South Africans consider important:

"Having access to care when needing it, is number one," she says. "This depends on the presence of facilities and medical personnel within a reasonable distance from home or work. Access is also determined by whether payment needs to be made at point of care, and the affordability thereof. So how care is funded and whether [Medical Aid] co-payments are payable at point of care are then also important."

If it comes down to access and affordability of quality care, then the only option South Africans really have is to find a Medical Aid or Hospital Plan that they can afford. Not what you wanted to hear? Well, let's look at the facts.

Universal healthcare access

South Africa has more than 400 public hospitals, with around 215 private facilities. Our public sector is funded by the state taking care of over 71% of the population; while the private sector, which serves 27% of the population, is mostly funded by individual contributions to roughly 73 Medical Aid schemes.

Government has proposed a National Health Insurance (NHI) scheme to provide universal healthcare. Private hospitals would stay, but financial roadblocks to healthcare would be removed, funded by additional personal tax supported by all tax-paying South Africans. Medical Aids would also stay, but its role would change. Instead of offering medical coverage for all health-related expenses, Medical Aids will only provide cover for expenses that can't be claimed through the NHI system.

Dr Mbuli says that South Africa needs three things to make better health for all a reality: "We need individuals and communities who have access to high-quality health services so that they take care of their own health and the health of their families, skilled health workers providing quality, people-centred care, and policymakers who are committed to investing in universal health coverage."

She warns, though, that universal healthcare doesn't mean everybody suddenly gets free access to all health services. That's up to a country and the "needs of their people and the resources at hand".

Quality care?

But access to healthcare is only part of the puzzle. There's also the quality of healthcare. Don't take our word for it. Here's Cyril Ramaphosa, writing in the 2018 Presidential Health Summit report:

"Since becoming the President of South Africa, I have received numerous complaints about the poor quality of healthcare that people experience in our clinics and hospitals ... complaints include inadequate access to medicines, equipment and technology, and numbers of staff in our facilities, unprofessional conduct of staff, labour unrest, corruption, and theft of hospital property."

That's a huge, huge problem.

"Improving the managerial skill level of senior leaders in medical facilities has been identified as a priority," says Dr Mbuli. "The quality of the care available at the public facilities also varies across the country, but the setup of the Office of Health Standards and Compliance will be driving improvements in this regard."

The real test

The good news is that, when the poop hits the proverbial propellor, South Africa's healthcare sector really can deliver. Take for example... ooh... maybe the biggest global healthcare emergency of our lifetimes: Covid-19.

Despite a slow start, South Africa's Covid-19 vaccine rollout quickly picked up speed— and other key aspects like the Electronic Vaccination Data System (EVDS) — showed how healthcare in South Africa can be reformed going forward, especially when there's collaboration between the private and public.

"These key elements include the successful collaboration between public and private sectors in prioritising and addressing the needs of patients," says Dr Mbuli.

It's also important to point out that the success was because of the partnership, not just because the private sector finally joined the public health party. It's not all roses in the private sector, there are challenges there too. As Dr Mbuli reminds us, "... fraud, waste and abuse take up an unnecessarily high percentage of the funding intended for care, even in the private sector."

Medical Aid in South Africa

Given that our private healthcare is of a globally competitive standard, we can assume that South Africa's Medical Aid and medical insurance companies help with that (looking at the numbers).

"South African Medical Aid cover, generally, tends to have a more hospital-based care focus," explains Dr Mbuli. "This emphasis is due to the legislated Prescribed Minimum Benefits, which ensure cover for the most serious of conditions. However, over time and due to the non-implementation of the initially envisaged Risk Equalisation Fund, contributions have become more expensive, and the expense of hospital-centred care has crowded out a lot of primary care benefits."

As a result, lower-income Medical Aid members have increasingly relied on the public sector or paying for private care out of their own pockets. "There is currently an effort to resume the determination of Low-Cost Benefit Options (LCBOs) to cater for millions of employed people who are keen to purchase such benefits," says Dr Mbuli.

If you're one of those Medical Aid members, then you should start getting into the habit of regularly comparing Medical Aids to make sure that your plan and premiums are still working for you as hard as they can. Especially as Medical Aid benefits and prices are updated every year.

The reality is Medical Aid is currently the ticket to quality care in South Africa. And it seems like it might stay that way for a while as the NHI faces many challenges. Securing funding, improving technical skills needed for a central system and gaining buy-in from healthcare professionals are no small tasks... so things might take some time.

So while you wait to see what comes next, compare a wide range of cost-effective Medical Aid options to be better prepared at accessing quality.

This article is for informational purposes only and should not be construed as financial, legal or medical advice.