South Africans are paying more for healthcare every year, yet both patients and providers are feeling increasing financial pressure.
Recent comments from Bestmed CEO Leo Dlamini highlight a growing concern within the private healthcare industry: medical schemes are spending more than they collect in contributions. According to Council for Medical Schemes (CMS) data, schemes spent roughly R103 for every R100 received from members.
That gap is currently being covered by reserves, but reserves are not an infinite solution.
Healthcare costs continue to rise faster than inflation, chronic disease is becoming more common and affordability pressures are making it harder for medical aid schemes to attract and retain younger members. At the same time, healthcare providers themselves are facing mounting operational strain.
The conversation around South Africa’s healthcare sustainability problem often focuses on hospitals, specialists, or medical aid premiums. There is another part of the equation that receives far less attention:
Operational inefficiency.
The Hidden Cost Problem Inside Healthcare Practices
Across South Africa, thousands of private healthcare practices still rely on fragmented administrative systems:
- Manual billing
- Paper records
- Multiple spreadsheets
- WhatsApp appointment management
- Disconnected calendars
- Delayed claim submissions
While these inefficiencies may seem small individually, collectively they create significant financial leakage across the healthcare ecosystem.
Missed appointments reduce revenue. Incorrect coding delays reimbursements. Manual claims increase administrative overhead. Poor record management creates disputes and resubmissions. Staff spend hours on repetitive tasks instead of patient care.
In an industry already under financial pressure, inefficiency quietly becomes a cost multiplier.
Why This Matters for Medical Aid Members
When healthcare delivery becomes more expensive, those costs eventually reach patients.
Medical schemes facing rising claims costs are often forced to increase premiums. Providers dealing with administrative complexity may increase consultation fees or reduce the number of medical aid patients they can realistically accommodate.
The result is a healthcare system where affordability continues to deteriorate for everyone involved.
Importantly, this is no longer only a “big healthcare” problem affecting hospitals and schemes. Independent healthcare practitioners are increasingly feeling the pressure too. Many smaller practices operate on tight margins and limited administrative capacity. Even relatively minor inefficiencies can have meaningful financial consequences.
The Efficiency Opportunity
As healthcare costs rise, improving operational efficiency may become one of the most important levers available to practices. This is where digital healthcare platforms like EZMed play a growing role.
Practice management software is no longer simply about convenience. It is becoming essential operational infrastructure.
By centralising appointments, billing, patient records, invoicing, and communication workflows, practices can reduce administrative friction and improve financial visibility.
For example:
- Automated billing reduces claim delays
- Centralised records improve accuracy and compliance
- Appointment reminders reduce no-shows
- Digital invoicing improves cash flow
- Integrated systems reduce repetitive admin work
These efficiencies may appear operational on the surface, but they directly affect practice sustainability.
In a healthcare economy where every percentage point matters, reducing unnecessary administrative loss becomes strategically important.
The Industry Is Moving Toward Digital Accountability
The broader healthcare sector is already shifting toward greater digitisation and accountability.
Medical aids increasingly require accurate coding and documentation. Regulators are placing greater emphasis on data governance and record-keeping. Patients expect faster communication and smoother healthcare experiences.
At the same time, healthcare providers are under pressure to deliver more care with fewer resources.
Practices that continue operating with fragmented systems may find it increasingly difficult to remain competitive, efficient, and financially resilient.
Sustainability Will Require More Than Premium Increases
The long-term sustainability challenge facing South African healthcare cannot be solved by premium increases alone. Instead, the industry may need to focus far more aggressively on operational efficiency, preventative care, smarter administration, and digital transformation. For independent healthcare practices, this presents both a challenge and an opportunity.
The practices that invest early in efficient systems, streamlined operations, and better patient management may be better positioned to navigate the increasing financial pressure facing the healthcare sector.
In the coming years, sustainable healthcare will not only depend on clinical excellence, it will depend on operational excellence too.