South Africa operates a two-tiered healthcare system: a public sector which caters for around 80% of the country’s population, and a private sector which caters for approximately a fifth of the population, funded primarily by members of either open or restricted medical schemes. Currently, the high cost of private medical aid puts it out of reach for the majority of South Africans.

If the COVID-19 pandemic has highlighted anything, it is the importance of quality healthcare. South Africa’s COVID-19 response successfully illustrated that the public and private healthcare sectors can co-operate. As the country tries to move towards the proposed model of universal healthcare under the umbrella of National Health Insurance (NHI), the critical issue now is how it will work and be funded. Has the public-private partnership achieved during the COVID-19 pandemic laid the foundation for a successful NHI?

A recent Business Day Dialogues LIVE, in partnership with ASI, unpacked the future of healthcare in South Africa. ASI is a Level 1 B-BBEE firm which offers independent health, wellness, insurance, investment and retirement advisory services.

The reality, said Anthony Govender, CEO of ASI, is that the state, on its own, does not have the capacity or resources to implement NHI. The only way it can be implemented is through collaboration between the public and private sectors.

While the last few months have highlighted the success of public – private partnerships in the healthcare sector, this time has also highlighted the importance of governance. Govender added South Africa as a whole has been disappointed at the number of reports of corruption in the healthcare sector, which once again broke the trust bank and placed the spotlight on leadership and governance – and the importance of holding people accountable.

There is no question, said Govender, that we need to be advocating for a strong ethical framework around public expenditure, as well as finding ways to improve state infrastructure.

While there is no denying that the issue of universal healthcare needs to considered, the questions that need to be addressed around the implementation of NHI include what it will cost, and how it will be funded and resourced. The reality, pointed out Govender, is that South African taxpayers are already over-burdened, a situation which is exacerbated by the recent growth in unemployment, and that in the current context, it will be hard to implement NHI.

Notwithstanding the various challenges, the COVID -19 pandemic period has been unprecedented and we did well to navigate it as a country. Global healthcare experts, including the World Organization (WHO) have lauded South Africa for its healthcare system, which fared brilliantly during the pandemic. Even though the country was one of the top 10 in infection rates, we had some of the best healthcare outcomes in the world, which is testament of the combined great value of our private and public healthcare resources. These facilities managing to attend to every patient infected with COVID-19 needing immediate attention, said Dr Ryan Noach, CEO of Discovery Health.

He further acknowledged the strong and courageous leadership of the Minister of Health, Dr Zweli Mkhize, for providing good guiding support to both the public and private sectors.

What COVID-19 has done is expose many of the challenges South Africa faces including poverty, inequality and unemployment, and these issues have played out in the healthcare space, said Dr Gunvant Goolab, an independent healthcare expert.

Principal officer of Bonitas Medical Fund, Lee Callakoppen, agreed that broader social constructs need to be considered when discussing the future of the country’s healthcare system.

The panel agreed that the cost of private medical aid could be brought down with the introduction of more affordable basic medical aid plans. However, this will require regulatory exemptions to allow schemes to reduce the number of Prescribed Minimum Benefits (PMBs) from the offering.

In 2020, medical schemes experienced a discontinuity in the usual healthcare utilisation patterns with higher COVID-19 related costs but a decline in non-COVID-19 related healthcare costs, explained Dr Noach. This has allowed most schemes to limit their member contribution increases for 2021.

They also concurred that given the complexity of medical aid and medical insurance products, independent, expert advice is invaluable.

To watch the online discussion, visit: