We provide all the information you need to know about health insurance in South Africa as well as how to choose the best private health insurance policy.
Healthcare is a hot topic in South Africa right now, with the government attempting to push through radical reforms to fix the ailing state system. With many questions surrounding the future of the healthcare system, it’s important that expats consider taking out a private insurance plan to ensure they are covered against any issues.
This helpful guide, provided by international health insurance provider Cigna Global, offers information on the following:
The healthcare system and health insurance in South Africa
The South African healthcare system has two tiers – public and private, with around eight in 10 residents relying on the public system. Unfortunately, the quality of public healthcare in South Africa is relatively poor; this is due to too few doctors, outdated facilities, and long waiting times.
A recent report by the Office of Health Standards Compliance found that only five of 696 public facilities hit targets for drug availability and controlling infections. This problem is exacerbated by the rising cost of private insurance; this is well out of reach of many South African residents.
The vast majority of expats moving to South Africa take out private cover to ensure they receive a standard of care on par with what they are accustomed to in their home country.
The National Health Insurance fund
In the last few years, the South African government has been pushing forward plans to set up a new state healthcare system, called the National Health Insurance fund (NHI). The government says the new system would create a higher healthcare budget and offer better standards of care for residents.
The NHI would involve combining public and private healthcare systems into one organisation. Critics say that introducing a new system would be highly complicated and would mean raising taxes; at this stage a full roll out seems years away.
In August 2019, a report by The South African found that the cost of bringing in NHI could be anything from R165bn to R259bn; meaning that individual taxpayers would need to contribute from between R7,850 and R12,300.
Who needs health insurance in South Africa?
State healthcare in South Africa is primarily designed to help the poorest citizens, for whom primary services such as emergency treatment, clinic visits, and consultations with doctors are provided free of charge.
Workers in South Africa need to be pay a contribution towards the cost of treatment from doctors and in hospitals; the specific amount depends on how much they earn.
The South African healthcare system boasts both public and private hospitals, so expats and higher earners generally take out private health insurance to benefit from better conditions and shorter
The National Health Insurance (NHI) is a health financing system that is designed to pool funds to provide access to quality affordable personal health services for all South Africans based on their health needs, irrespective of their socio-economic status. NHI is intended to ensure that the use of health services does not result in financial hardship for individuals and their families.
NHI seeks to realise universal health coverage for all South Africans. This means that every South African will have a right to access comprehensive healthcare services free of charge at the point of use at accredited health facilities such as clinics, hospitals and private health practitioners. This will be done using an NHI card. The services will be delivered closest to where people live or work.
NHI is being implemented in phases over a 14-year period that started in 2012. It will be established through the creation of a single fund that will buy services on behalf of the entire population, The funding for NHI will be trhough a combination of various mandatory pre-payment sources, primarily based on general taxes.
The White Paper on National Health Insurance was published for comment on 11 December 2015. Members of the public should submit their comments before 11 March 2016.
On 30 June 2017 the National Health Insurance policy document was gazetted after approval by Cabinet.