World Health Day 2024, with the theme “My Health, My Right,” is a call to action for everyone to have access to essential health services, education, and information. This theme is particularly relevant in South Africa, where access to healthcare is far from equitable, and accessing private healthcare in particular can be limited due to financial constraints. Even with medical aid, individuals often face significant co-payments or medical expense shortfalls, which can prevent them from fully enjoying their right to health. Gap cover has become essential in assisting more South Africans in managing medical expenses within their existing medical schemes. .
The challenge of healthcare access
South Africa has well-acknowledged challenges when it comes to healthcare access. In the public sector, there are simply not enough facilities nor staff to ensure consistent access to quality healthcare. While the National Health Insurance (NHI) Bill is aimed at addressing this, the reality is that this in itself is fraught with even more challenges. Even in countries where free healthcare is available to all, such as the National Health Service (NHS) in the United Kingdom, there are issues with long waiting times for treatment, which again impacts people’s right to access quality healthcare.
The financial barriers are one of the major reasons why access to healthcare remains unequal and why public healthcare services cannot keep up with demand. This is a common global problem. In fact, the World Health Organisation (WHO) Council on the Economics of Health for All has identified that, while at least 140 countries recognise health as a human right in their constitutions, only four countries have mentioned how to finance it.
The right to health in South Africa
Until such time as South Africa can effectively address the universal healthcare challenge, private healthcare will continue to play an essential role. Accessing this means medical aid is vital, However, escalating medical costs have compelled medical schemes to introduce a multitude of different options, offering different levels of coverage. Within this, leaves potentially significant gaps between the level of coverage and what private specialists and hospitals charge. This means that individuals will continue to face medical expense shortfalls, especially when specialists charge many times more than the rate that medical schemes will pay.
Shortfalls can accumulate to substantial amounts, as evidenced by some our clients’ lifetime claims. For instance, we have covered R502,983 for cancer treatment that exceeded the medical scheme’s coverage, and R414,331 for multiple instances of spinal stenosis treatment. These examples illustrate the significant financial gaps individuals may face, even when they are on premium medical aids.
These shortfalls, which often can exceed R100,000 for a single event, present a significant financial burden. Covering these expenses out of pocket can deter individuals from seeking the ultimate level of treatment. Gap cover has become invaluable in ensuring that South Africans can access quality healthcare without facing overwhelming financial strain. By investing in gap cover, individuals can safeguard themselves from such financial pressures and ensure that they have access to the healthcare they require at a more manageable cost.
While gap cover is not the sole answer to South Africa’s healthcare access challenges, it supports the WHO’s goal of Universal Health Coverage (UHC) by ensuring that more people can access a wider range of services without financial hardship. In settings where public healthcare systems are under-resourced or overburdened, such as in South Africa, gap cover can provide a critical safety net.
About Turnberry Management Risk Solutions Founded in 2001, Turnberry is a registered financial services provider (FSP no. 36571) that specialises in Accident and Health Insurance, Travel Insurance, and Funeral Cover.
With extensive experience across healthcare and insurance industries in South Africa, Turnberry offers unsurpassed service to Brokers and clients. Turnberry’s gap cover products are available to clients on all medical aid schemes, as they are independently provided and are therefore transferable in the event of a change in the client’s medical aid scheme.
Turnberry is well represented nationally, with its Head Office based in Bedfordview, Johannesburg with Business Development Managers in Cape Town and Durban. The Turnberry Team’s focus on outstanding client service comes from having extensive knowledge and experience in the financial services sector and is underwritten by Lombard Insurance Company Limited. Lombard Insurance Company Limited is an Authorised Financial Services Provider (FSP 1596) and Insurer conducting non-life insurance business.