South Africa’s path to better healthcare lies in leveraging and expanding its private medical expertise, not in replacing it with a state-run National Health Insurance (NHI) system.

The ongoing debate over NHI has placed South Africa at a crossroads, with policymakers facing stark choices about how best to deliver quality healthcare to all citizens. While advocates of NHI argue for a single state-run system, the evidence points to a different solution. Expanding and harnessing the capacity, skills, and innovation of the country’s private medical sector.

South Africa’s private healthcare sector currently delivers a high standard of care, drives innovation, and trains a steady stream of doctors, nurses, and specialists. Polling data confirm strong public support for this approach. A majority of South Africans prefer a two-tier healthcare system, in which people can decide for themselves who they purchase their own health insurance from and where they get medical treatment, rather than nationalising medical aid funds and hospital groups.

The risk with a shift to NHI is that it would undermine what already works. It would disincentivise private investment, prompt a skills exodus, and limit choice for patients. International experience shows that universal coverage is best achieved by encouraging both public and private sectors to compete and collaborate, ensuring efficiency and raising standards across the system. South Africa’s own record in medical training, hospital management, and specialist care shows the potential of the private sector when regulatory burdens are reduced and expertise is allowed to flourish.

Expanding private medical expertise through partnerships, investment incentives, and more flexible regulation would boost healthcare outcomes and keep skilled professionals in the country. Preserving and growing this capacity is critical if South Africa wants world-class care for all.

South Africa’s healthcare future depends on pragmatic solutions, not ideological fixes. Building on private sector strength can deliver real gains in quality, access, and innovation.