Only about 14% of South Africans are covered by medical aid, with young adults aged between 20 and 24 having the lowest levels of coverage.

This is according to a new report from Statistics South Africa (Stats SA), Expenditure on Health in South Africa: Findings from the Income and Expenditure Survey, 2022/23, which was published last week.

The report found that there were significant disparities in medical aid coverage between provinces.

The proportion of people covered by medical aid was 23.8% in the Western Cape, followed by Gauteng (19.6%), the Northern Cape (14.3%), the Free State (14.0%), North West (11.6%), Eastern Cape (10.2%), KwaZulu-Natal (9.6%), Mpumalanga (8.4%), and Limpopo (7.3%).

Coverage for South Africa as a whole was 14.1%.

There were also significant differences by age group. Only 7.8% of people aged between 20 and 24 were covered by medical aid, the lowest of the age cohorts analysed by Stats SA’s report. The highest coverage was for people aged between 75 and 79, where 31.8% of people had medical aid coverage.

The low levels of adults in their early 20s is likely because many will still be at university or starting their careers, and if they had been on medical aid previously, they would have been covered by their parents’ plans. As people of that age are generally healthy, they would put off getting medical aid until they are older and are earning more money to cover the expense.

White South Africans were also the most likely to be covered by medical aid, with 70.3% having medical aid. Some 42.2% of Indian South Africans had medical aid, followed by coloured South Africans, at 17.7%, and black South Africans, with 7.9%.

Marius Roodt, deputy editor of The Common Sense, said these disparities in coverage could be seized upon by ideologues in the African National Congress and National Health Department as evidence for the need for the National Health Insurance (NHI) scheme, which would effectively nationalise private healthcare in South Africa.

“There will be claims that because of these disparities there is a need to create the NHI, which in theory will provide free and decent levels of care to all South Africans. Nothing could be further from the truth. Implementing NHI will only destroy South Africa’s world-class private healthcare system,” Roodt said.

“Anyway, South Africa already provides healthcare for poorer people through government hospitals and so on. However, these are run poorly and resources are wasted. If their management was improved and resources used properly, people without medical aid would have access to decent levels of care through the government system,” he continued.

“The solution is not to nationalise the private sector. It is to fix the public healthcare system and also to increase the number of people on medical aid. This could be done fairly easily through allowing low-cost medical aids to cover people on lower incomes or by making it compulsory for employed people to be on a medical aid. This could be subsidised by employers who could be given tax breaks for these subsidies. There are a number of solutions other than NHI that exist to ensure all South Africans receive decent levels of healthcare,” Roodt said.