Medical Schemes in South Africa

Medical schemes are the vehicles for providing private health insurance in South Africa. Medical schemes reimburse their members for actual expenditure on health. They operate on a not-for-profit basis and are essentially mutual societies, governed under the Medical Schemes Act (Act 131 of 1998) and managed by boards of trustees. On a practical level they are guided by a number of for-profit entities that provide administration, marketing, managed care, consulting and advisory services.

Regulatory Oversight by the Council for Medical Schemes

  Legislation and Regulations Circulars to Industry  

Industry Organisation: Board of Healthcare Funders

Resources on Medical Scheme issues:

Academic and Published Articles

•Harrison S., Bhana R., Ntuli A., editors (2007). The Role of the Private Sector within the South African Health System. In: South African Health Review 2007. Durban: Health Systems Trust; 2007.

•McIntyre D., Thiede M. (2007) Health Care Financing and Expenditure In: Harrison S., Bhana R., Ntuli A., editors. South African Health Review 2007. Durban: Health Systems Trust; 2007.

•McLeod H., Ramjee S. (2007) Medical Schemes. In: Harrison S., Bhana R., Ntuli A., editors. South African Health Review 2007. Durban: Health Systems Trust; 2007.

•Broomberg, J editor. (2006) Consultative Investigation into Low Income Medical Schemes. Final Report. 7 April 2006.