With barely 14% of the country’s population covered by medical aid, new data reveal a deepening crisis in healthcare affordability, where race, geography and income determine who gets treated and who doesn’t, reports The Citizen. A StatsSA survey has found that in 2022-23 households collectively spent R103.5bn in medical aid contributions, yet only 14.1% of the population holds medical aid coverage.
The latest data, released last week from Statistics South Africa’s (Stats SA) Income and Expenditure Survey 2022-23, expose the scale of inequality in how households access and pay for medical care.
The report features medical aid contributions running into the billions, while millions of families pay entirely out of pocket for basic health services.
Additionally, the survey, conducted between November 2022 and November 2023, found that households collectively spent R103.5bn in medical aid contributions during this period, yet only 14.1% of the population holds medical aid coverage.
The remaining 85.9% are entirely uncovered.
Medical aid gap wider than most realise
Nearly 70% of white South Africans hold medical aid, compared with just 7.9% of black African people, well below the national average. The Indian/Asian population sits at 42.2% coverage, with coloured South Africans at 17.7%.
Statistician-General Risenga Maluleke said the findings were intended to directly inform planning.
“The information will assist programme managers in the planning of health-related programmes and inform policy-making in the health systems,” he said.
Young adults aged 20 to 24 are the least-covered age group, at 7.8% within their cohort, while coverage rises sharply with age, reaching 31.8% among those aged 75 to 79.
This pattern shifts when broken down by race: black African people dominate coverage in younger age groups, while white South Africans hold the majority of coverage from age 55 upwards.
Western Cape leads medical aid coverage, Limpopo trails behind
Medical aid coverage varies significantly across South Africa’s nine provinces, with the Western Cape recording the highest coverage at 23.8%, followed by Gauteng at 19.6%. Both provinces sat well above the national average of 14.1%.
Northern Cape and Free State sat close to the national average at 14.3% and 14.0%, respectively.
Meanwhile, the Eastern Cape recorded 10.2% and the North West 9.6%, both below the national benchmark but still in double figures.
KwaZulu-Natal, despite being one of the country’s most populous provinces, recorded coverage of just 9.1%.
Mpumalanga sat at 8.4%, while Limpopo records the lowest medical aid coverage in the country at 7.3%.
The provincial disparities mirror broader patterns of economic inequality and urbanisation across the country. Urban settlements recorded coverage of 19.1%, above the national average, while traditional settlements record just 3.9%. Farm settlements sit at 12.1%, also below the national average.
Men contribute more, women outnumber them in coverage
Male-headed households contributed R71.8bn toward medical aid – more than twice the R31.7bn contributed by female-headed households – despite females holding slightly higher coverage rates (14.3% versus 13.9%).
On average, male-headed households paid R27 662 annually, compared with R20 875 for female-headed households.
White households contributed the most in absolute terms at R48.1bn, followed by black African households at R40.4bn. However, despite being the second-largest contributor overall, black African households paid the lowest average contribution of any group at R18 561, revealing how sheer numbers mask per-household financial strain.
Gauteng households led the province’s contributions at R36.1bn, with the Western Cape second at R28.3bn.
On a per-household basis, though, the Western Cape tops the country at an average annual contribution of R36 009.
Out-of-pocket spending hits hardest where coverage lowest
Beyond medical aid, households spent an additional R31.5bn out of pocket on health services, averaging R1 481 per household, representing just 1% of total household expenditure.
The wealthiest quintile accounted for R22.5bn of that total, or 71.3%, spending an average of R5 285.
The poorest quintile spent only R674m in total, averaging R158 per household.
Stats SA’s report shows that the burden falls disproportionately on those already most vulnerable. Poor households – those living below the lower bound poverty line – spent just R1.5bn on health with an average of R316, while non-poor households spent R30 billion at an average of R1 828.
Medicines accounted for R11.2bn of out-of-pocket spending, split roughly between prescription (R5bn) and non-prescription purchases (R4.5bn).
Assistive products for vision, like spectacles, accounted for R3.5bn, while outpatient curative and rehabilitative services cost households R3.2bn.
Despite the pressure, 87.1% of households reported being able to afford their prescribed medication. Still, nearly one in 10 , 9.6%, said they could not.
Most South Africans, 71.6%, rely on the public health sector for their usual care, with public clinics serving 65.7% of the population. Only 1.4% use private clinics, and 1.8% private hospitals.
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