Rare disease funding is under scrutiny after the Council for Medical Schemes (CMS) Appeals Committee ordered KeyHealth to cover a teenager’s treatment in full. The Board of Healthcare Funders (BHF) says the case shows why schemes need a way to share the cost of exceptionally expensive treatments. The 15-year-old has paroxysmal nocturnal haemoglobinuria, a rare blood disorder. Treatment with AstraZeneca’s…
Tag: Medical Schemes
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Value-Based Care Can Advance Reform Before NHI
Value-based care could help South Africa improve private healthcare affordability before National Health Insurance (NHI) disputes are resolved, an industry commentary argues. The commentary urges medical schemes, funders and providers to redesign payment arrangements within existing frameworks. It contends that pooling funds under NHI will not control costs unless purchasing incentives also change. A larger purchaser paying for each service…
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Six Factors Driving Medical Scheme Increases in 2027
Medical scheme increases for 2027 range from 7.35% to 8.9%, as rising healthcare utilisation, ageing membership and expensive new treatments continue to push costs above inflation. Industry representatives say schemes must raise contributions to cover growing claims expenditure. According to the Council for Medical Schemes (CMS), healthcare costs can absorb up to R96 of every R100 contributed. Why Medical Scheme…
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Gap Cover Undermines Scheme Cost Controls
Gap cover, medical schemes and primary healthcare plans are shifting costs between one another, undermining efforts to contain healthcare spending, actuaries have warned. Four Medscheme actuaries presented the findings at the Actuarial Society of South Africa convention in Cape Town. PMBs squeeze other benefits According to senior actuarial analyst Elizabeth Greyling, prescribed minimum benefits (PMBs) accounted for 70% of healthcare…
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RAF Medical Expense Claims: SCA Blocks Scheme Deductions
RAF medical expense claims cannot be reduced because a medical scheme has paid or will pay treatment costs, the Supreme Court of Appeal (SCA) has ruled. Discovery Health welcomed the unanimous judgment, delivered on 16 October 2026, saying it protects members’ rights and supports medical schemes’ recoveries. The ruling follows litigation over RAF directives that sought to exclude expenses already…
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NHI implementation: Rights, Funding and Legal Scrutiny
NHI implementation must advance equitable healthcare access despite legal delays. However, constitutional obligations and the merits of a particular funding model remain separate questions. Section 27 guarantees access to healthcare services. It requires reasonable legislative and other measures, within available resources, to progressively realise that right. It does not prescribe NHI as the required financing mechanism. In February 2026, the…
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Medicine Price Increase Adds R1bn to Scheme Costs
An extraordinary medicine price increase could add R1bn to medical schemes’ costs in 2027, after schemes submitted their budgets. The Health Department announced the additional 2.88% single exit price (SEP) adjustment on 30 September, effective from 1 October. It cited cost pressures for pharmaceutical manufacturers, including geopolitical tensions. The adjustment follows an earlier 1.47% increase in 2026. Although annual increases…
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JSE healthcare shares: Aspen leads gains
JSE healthcare shares have advanced this year, with Aspen Pharmacare’s recovery outpacing gains at Netcare and Life Healthcare. However, analysts say sustained growth will depend on manufacturing execution and hospital patient volumes. Aspen has gained about 40% since January and more than 60% over 12 months. At roughly R160 this week, its market value stood near R69bn. Aspen Leads JSE…
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Medical Aid Contributions for 2027 from Discovery and Momentum
TWO of South Africa’s largest open medical schemes have unveiled their 2027 medical aid contribution increases. Discovery Health Medical Scheme (DHMS) is raising rates by an average weighted increase of 8.2%. Momentum Health is raising rates by 7.9%. Both framed the increases as a response to mounting medical inflation. Discovery: 8.2% on average DHMS contributions will rise between 7.4% and…
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Netcare patient volumes support FY guidance
Netcare patient volumes increased in the 2026 financial year, helping the private hospital group remain on track to meet its full-year guidance. Total paid patient days (PPD) rose by about 1.6% for the year ended September, while acute PPD increased by approximately 0.8%. However, medical scheme measures to strengthen solvency constrained activity in the acute hospital portfolio. These measures included…
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Medical Aid Contributions: 3.8% Target Won’t Fix Affordability
A 3.8% guideline for 2027 medical aid contributions will not make private healthcare more affordable, the Board of Healthcare Funders (BHF) says. Instead, managing director Dr Katlego Mothudi says structural reforms are needed to tackle rising hospital and specialist costs and higher utilisation. Unexplained component in the 2027 guideline Speaking in a broadcast interview, Mothudi said the main problem lies…
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Ageing with HIV Puts New Pressure on the Health System
South Africa’s treatment success means ageing with HIV is now a major health system challenge. By 2040, more than half of people living with HIV in the country will be 50 or older, up from 30% in 2025, according to a recent Lancet report. That is 3.9 million people, up from 2.3 million. South Africa has the world’s largest HIV…