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The Common Sense has been investing more time and resources into deep-dive analyses of the key driving forces shaping South African society and its economy. One of those is access to healthcare.

The following six charts set out how South Africans access healthcare. 

The chart below shows the type of healthcare facility that South African households consulted first when they needed medical attention in 2025.

Public facilities together accounted for 73.3% of all first consultations. Private facilities accounted for 26.7%.

The table below shows the type of healthcare facility that South African households consulted by province.

There were extreme variances. For example, in the Western Cape, 56.8% consulted a public facility, and 43.2% consulted a private facility, whereas in Limpopo the figures were that 85.8% consulted a public facility, and 14.2% consulted a private facility.

The table shows how private healthcare access correlates to employment and income levels, and that improving access to private health resources can therefore only be achieved by raising employment and income rates. What appears to be a problem of healthcare access in South Africa is actually a problem of low growth and high unemployment.

The third chart shows the share of people in each province who belonged to a medical aid scheme in 2025.

Again, the same point stands out: private healthcare access is a function of employment and income levels more than anything else.

The fourth chart shows medical aid membership in South Africa's major metropolitan areas.

Note that in all the metros access is higher than the national average figure of 15.5%, which is a function of the fact that people in cities enjoy better employment and income prospects than those in smaller towns and rural areas.

The fifth chart shows two things together: the share of each population group that belonged to a medical aid scheme in 2025, and the share that each group made up of all medical aid members.

The white share dominates the left of the chart given its generally middle-class standing. The black share dominates the right of the chart indicating the extent to which black South Africans have come to dominate South Africa’s middle classes. (Readers might be interested in The Common Sense’s recent writing on the black middle classes and the ownership of the stock exchange.)

The sixth chart and final chart shows how the population group composition of medical aid membership has changed since 2002.

In 2002, black South Africans and white South Africans each accounted for roughly 42.0% of all medical aid members. The black share has increased steadily since then and is projected to reach 51.1% in 2026. The white share is projected to fall to 31.6%. The coloured and Indian or Asian shares have changed little, and are projected to stand at 10.3% and 7.1%, respectively. This chart is a most important insight into the evolution of South African society, and the trend line will accelerate over the next two generations as the white contribution to the national population falls into relative insignificance in numerical terms.

As an aside, the African National Congress’s (ANC’s) hostility to private medical aid coverage and the threat this poses to the broader middle class sits most uncomfortably alongside these data, showing how such hostility now amounts to an attack on the core of its urban voting bloc.

What South Africa faces is not, in the first instance, a healthcare access problem. It is an employment and economic growth problem that presents itself as a healthcare access one. Every chart above tells the same story: where employment and economic activity are concentrated, access to quality healthcare rises. In the Western Cape and Gauteng, where formal employment is highest, medical aid coverage runs at roughly double the national figure and private facilities account for a far larger share of first consultations. In Limpopo, where employment is lowest, private facilities account for 14.2% of them.

Reduce unemployment and raise incomes, and the number of South Africans covered by a medical aid scheme rises with them, without any redistribution of existing capacity at all.

There is a political dimension to this that the governing party appears not to have absorbed. Medical aid membership is no longer what it was in 1994, when whites accounted for the bulk of membership. The black share is projected to reach 51.1% this year whilst the white share will fall to just over 30.0%. The private medical aid market is now dominated by the black middle and aspirant middle class. It is precisely that constituency, urban, employed, and upwardly mobile, that would bear the cost of any attempt to nationalise the savings held in private medical aid schemes, and precisely that constituency that the ANC can least afford to lose at the ballot box.