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Industry Overview

There are 76 medical schemes in South Africa with approximately 8.88 million members. 18 of these medical schemes are open to the public and 58 are restricted medical schemes, mostly offered by big companies exclusively for the benefit of their employees (Council for Medical Schemes Annual Report 2020-2021).

Anglo Medical Scheme is a restricted Scheme, exclusively for employees of participating employer groups.

How is the industry regulated?

The Department of Health

The Department of Health is the executive department of the South African government that is assigned to health matters. It is the overall governing body for the healthcare industry in South Africa. Dr Pakishe Aaron Motsoaledi is the incumbent Minister of Health.

Council for Medical Schemes

The Council for Medical Schemes is a statutory body established by government to supervise private health financing by medical schemes and to interpret the laws drawn up by the Department of Health.

Medical schemes are governed by the Medical Schemes Act 131 of 1998, which supplements the National Health Act.

Other Governing Bodies / Associations

Besides the Department of Health and the Council for Medical Schemes, the following representations and regulatory bodies govern the industry:

The Board of Healthcare Funders of Southern African (BHF)

BHF is a representative organisation for medical schemes in South Africa, Namibia, Zimbabwe, Botswana as well as Lesotho. This is an organisation that provides relevant, up-to-date information; engages with government on behalf of medical schemes and provides services to the industry.

Health Funders Association

Established in 2015, the Health Funders Association (HFA) is a non-profit organisation representing stakeholders involved in the funding of private healthcare in South Africa.

The HFA represents some of the country's most prominent medical schemes, representing approximately 73% of open schemes and 50% of the total memberships. Through its membership of three of the largest medical scheme administrators HFA represents 3.8 million people and 17 medical schemes.

Health Professions Council of South Africa

The Health Professions Council of South Africa is a statutory health professional council. It was established in terms of the Health Professions Act 56 of 1974.

The purpose of the Council is to provide for control over the training, registration and practices of healthcare practitioners and to provide for matters incidental thereto.

South African Pharmacy Council

The South African Pharmacy Council is a statutory health professional council. It was established in terms of the Pharmacy Act 53 of 1974.

The purpose of the Council is to ensure the provision of quality pharmaceutical services in South Africa by developing, enhancing and upholding universally acceptable standards, professional ethics and conduct, ongoing competence and pharmaceutical care.

South African Nursing Council

The South African Nursing Council is a statutory health professional council. It was established in terms of the Nursing Act 33 of 2005.

The purpose of the Council is to control and exercise authority in respect of the education, training and manner of practices pursued by registered nurses, midwives, enrolled nurses and enrolled nursing auxiliaries.

National Health Insurance

National Health Insurance (NHI) and South Africa's journey to Universal Healthcare (UHC) is not a topic one can summarise easily.

In addition to updates in MediBrief on the current developments, we would like to direct you to further documents and background information, which will give you more detailed insight into the topic:

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