A new Alexander Forbes Health report warns that SA’s medical scheme industry is under increasing financial strain as healthcare costs, claims utilisation and the burden of chronic disease continue to rise.
The analysis found that the overall risk claims ratio increased from 95.8% in 2023 to 96.2% in 2024, indicating that a growing share of contribution income is being spent on claims. Restricted schemes were particularly affected, recording a claims ratio of 101.3%, meaning they paid out more in claims than they collected in contributions. The industry’s operating deficit widened to R11.64bn in 2024 from R10.2bn the previous year, forcing many schemes to rely on investment income to remain financially viable. Although membership grew marginally to 9.04m beneficiaries, open schemes experienced declining membership, reflecting affordability challenges. An ageing membership base and fewer young entrants are further increasing claims costs, raising concerns about the long-term sustainability and affordability of medical scheme cover. – Business Day (4 June 2026)