A landmark international study finds that hospitals with better nurse staffing and work environments not only benefits nurses but is significantly associated with less physician burnout and job dissatisfaction. The research, published in JAMA Network Open, provides a clear solution to the global crisis of physician burnout.
A research team, led by Penn Nursing’s Center for Health Outcomes and Policy Research (CHOPR), surveyed more than 6400 physicians and 15 000 nurses across the United States and six European countries (Belgium, England, Germany, Ireland, Norway, and Sweden). The findings show that hospitals with better nurse staffing, supportive work environments, and effective interdisciplinary teamwork had substantially lower rates of physician burnout, job dissatisfaction, and intent to leave.
“Physician burnout is a global crisis, but few actionable solutions have been identified,” said Linda H. Aiken, PhD, RN, FAAN, FRCN, Professor of Nursing and Sociology and Founding Director, CHOPR. “Our study provides evidence that investing in nurses is a ‘two-for-one’ solution – improving both nurse and physician wellbeing while also strengthening patient care.”
Key findings include:
In US hospitals, a modest 10% improvement in the nurse work environment including staffing adequacy was associated with a 22% reduction in physician intent to leave, a 25% reduction in physicians unwilling to recommend their hospital as a place to work, a 19% reduction in physician job dissatisfaction, and a 10% reduction in physicians experiencing high burnout.
In European hospitals, a 10% increase in nurse staffing adequacy was linked to 20% lower physician intent to leave, 27% lower odds of not recommending their hospital, 15% lower physician job dissatisfaction, and 12% lower odds of high burnout.
Hospitals with stronger physician-nurse teamwork consistently reported better physician outcomes.
The results come at a critical time, as both physicians and nurses face unprecedented levels of stress, burnout, and turnover. According to the study, 20–44% of physicians surveyed reported intentions to leave their hospital positions due to dissatisfaction, and up to 45% reported high burnout.
“These findings highlight a path forward that hospital leaders can act on immediately,” said Karen B. Lasater, PhD, RN, Chair in Nursing and Health Policy, Associate Professor, and Associate Director, CHOPR. “Improving nurse staffing and creating supportive work environments are organisational reforms that are feasible, evidence-based, and capable of retaining both nurses and physicians.”
Fundi, South Africa’s leading education finance and student solutions provider, has launched FundiHealth: a healthcare platform designed to meet the unique needs of students, young professionals and organisations committed to supporting the health and wellbeing of their people.
As part of its digital transformation and enablement strategy, Fundi has launched its own healthcare platform: FundiHealth.
Born out of Fundi’s deep understanding of the challenges students face and the recognition that health is a critical enabler of success, the platform offers affordable quality healthcare solutions for students and young professionals. “We’ve always believed that education unlocks potential, but we also see every day how poor health and the inability to afford care can derail even the most promising futures,” explains Benedict Johnson, Fundi Executive Head: EBS and New Initiatives. “Our platform was created with one clear purpose in mind: to remove healthcare as a barrier to education, productivity and meaningful participation in the economy.”
Fundi CEO Mala Suriah, moderator on the day ,Thembekile Mrototo and Fundi Executive Head Benedict Johnson at the FundiHealth launch.
The solution has been launched at a time when South Africa is grappling with a significant gap in healthcare coverage. According to the Council for Medical Schemes (2024), over 80% of South Africans do not belong to a medical aid scheme and rely entirely on the overstretched public health system. Young people are particularly vulnerable notes Charles Irumba, FundiHealth Executive: “Research from the Board of Healthcare Funders (2023) shows that fewer than 12% of students and young professionals under the age of 30 have adequate medical cover. This lack of access has serious implications not only for individual wellbeing but also for South Africa’s productivity and growth.” Data from Statistics South Africa (2024) further supports this; with absenteeism due to preventable illness costing the economy over R16 billion annually, with students and entry-level workers among the most affected.
“When students drop out of school because of untreated illnesses – including stress, depression or anxiety – or when young professionals miss work and lose income as a result, it has a detrimental effect on them as well as their families,” says Irumba. “FundiHealth ensures that young South Africans stay healthy in class and at work, contributing meaningfully to their futures and to our country’s growth and development.”
The new platform offers affordable, accessible medical cover that includes access to private doctors, medication, mental health support and preventative care services, all designed to fit the budgets of students, families and young professionals. “Critically, we’ve also created an option that allows organisations to offer their entry-level staff healthcare benefits at a fraction of the cost of traditional schemes. This is ideal for SMMEs and growing businesses, as it will assist them improve staff retention, morale and productivity,” adds Johnson. “Employers often underestimate the economic impact of poor health among their youngest and most vulnerable employees. By offering a healthcare solution like FundiHealth, they’re not just supporting their people, they’re strengthening their businesses too. Healthy employees are more engaged, more present and more productive. It’s a win-win.”
Beyond immediate productivity benefits, FundiHealth also has the potential to alleviate pressure on South Africa’s public health system by shifting some demand into the private sector and by promoting preventative care among young people. “If we want to grow as a nation, we have to keep our young people healthy in body, mind and spirit,” notes Irumba. “That’s what FundiHealth is all about. Good health is not a ‘nice-to-have’. It is a fundamental part of what it takes to succeed.”
FundiHealth is available to students, their families, young professionals and organisations at fundihealth.co.za. Customers can both explore different plan options and sign-up online.
“With FundiHealth, we’re tackling one of the most overlooked challenges to achieving one’s full potential: health. Good health underpins everything. By keeping our students and young professionals healthy, we’re keeping their dreams alive and South Africa moving forward,” Johnson concludes.
By Tony Singleton, CEO at Turnberry Management Risk Solutions
21 October 2025
You plan for retirement, save for your child’s education, and try to build a financial cushion, but what happens when medical co-payments chip away at those plans, year after year? It starts small: a R5,000 co-payment for a scope. Then a few months later, a R12,000 shortfall for a hospital admission. Fast forward five years, and you’ve spent tens of thousands on out-of-pocket medical costs that your medical aid didn’t fully cover.
Medical aids cannot keep pace with the rate of medical inflation while still maintaining affordable premiums, so co-payments grow each year, more sub-limits are introduced, and specialist fees continue to outpace medical aid rates. This means more and more South Africans are finding themselves forced to draw from their retirement funds or take on debt to cover medical aid shortfalls. Medical aid alone is no longer enough to protect your financial future – gap cover has become essential.
How medical expense shortfalls silently accumulate
Medical scheme members, especially those on higher-end plans, often assume they are covered for any medical eventuality – until it is time to actually claim for a significant medical event. Even comprehensive plans can fall short when it comes to specialist charges, hospital procedures, or newer, high-tech treatments. Many specialists charge as much as five or six times the scheme rate, and certain procedures have limits to what medical aid will pay or require an up-front co-payment. While your medical aid might pay a portion, the remainder becomes your responsibility.
This can become a compounding problem. What starts as a few isolated bills adds up. Over time, shortfalls from surgeries, diagnostics, scopes, chronic illness treatment, or specialist consultations can add up to hundreds of thousands of Rands. For example, one Turnberry client managing spinal conditions, lupus, and gastro-oesophageal reflux disease (GERD) claimed R478,000 across 27 incidents in only five years. Another has claimed R450,000 across 54 incidents related to lung disease and spinal conditions, and a third, with multiple chronic issues, has received over R448,000 in gap cover payments over the same period. As the years go by, these amounts continue to add up, and this is becoming an increasingly typical pattern. Many families are forced to pause investments, take out loans, or remove money from their retirement annuities to keep up with these uncovered and unanticipated expenses.
Gap cover has become essential
Gap cover was created precisely to tackle these medical expense shortfalls, with an affordable policy that sits alongside medical aid and offers cover for medical expense shortfalls, co-payments, sub-limit cover, oncology shortfalls, prosthesis costs, and even casualty visits. Where medical aid benefits have tightened to control premiums, gap cover has expanded to fill the void.
Many South Africans still believe gap cover is a nice-to-have or something that is only necessary later in life. The reality, though, is that shortfalls affect people no matter what age they are, from broken bones in their 20s to maternity bills in their 30s or chronic conditions emerging in their 40s and beyond. Joining early also makes a difference, as you are covered from the start and your premiums will remain lower than someone beginning their cover at 65, when age-based premium increases and health exclusions may apply. Gap cover is not just for major surgeries or cancer treatments; it is valuable for more routine procedures as well as accidents and emergencies. And its value increases over time, especially if you remain continuously covered and avoid reintroducing waiting periods.
A long-term strategy, not a short-term fix
By staying on gap cover year after year, members build a stable financial buffer against the cumulative effect of medical costs. We’ve seen clients rely on gap cover for decades of health events, not just one-off emergencies, and the value of continuous cover is evident in our lifetime claims figures. Gap cover is no longer a luxury, it is an essential tool for building long-term financial resilience. Without it, medical aid shortfalls can easily undo years of careful financial planning. Talk to your broker about finding the best gap cover solution to fit your needs.
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.
By Christina Mooki, Head of Acquisition Operations at Merchant Capital
Pharmacies, especially ones in rural areas, are often the cornerstone of their communities. Beyond filling prescriptions, they provide medication, medical equipment, and counselling, sometimes serving as multi-service clinics in small towns and outlying areas. When people cannot wait weeks for a doctor’s appointment or need trusted advice, the local pharmacy is their first stop.
In many outlying areas, it is not just the most practical option, but often the only one. With the country’s high and rising burden of chronic disease, this role will only grow in importance.
The sector is indeed expanding. In just two years, 2020 and 2021, about 648 new community pharmacies opened across South Africa. By 2021, the total number stood at roughly 3580 outlets, and nearly 70% of these were independent rather than corporate-owned. That is over 2000 small businesses carrying community healthcare.
Christina Mooki, Head of Acquisition Operations at Merchant Capital
But every pharmacy is also a business. Behind the scenes, owners are juggling supplier deliveries, unpredictable supply chain issues, negotiating credit terms, paying staff, and trying to keep overheads under control. Balancing that with the responsibility of keeping communities healthy makes pharmacy ownership uniquely challenging and uniquely important.
Why more pharmacies are needed
A growing number of South Africans are living with chronic illness such as diabetes, hypertension, and HIV. These patients cannot miss their repeat medications and local pharmacy access becomes essential. Independent outlets do more than only dispense medicine, they also cut travel time, keep treatment within reach, and help build local economies.
Around the world, the role of a pharmacy is expanding. They are no longer limited to handing out prescriptions. According to Deloitte, many pharmacies are transforming into community health hubs by adding point-of-care testing, preventative health screening, and digital services to meet the changing expectations of modern consumers. Locally, they are also incorporating retail services to diversify their offerings further.
Running a pharmacy like a retailer
Passion for helping people will take you far as a pharmacist, but on its own, it will not keep the doors open. Independent pharmacies need to be run with the same discipline as any other retailer. Cash flow must be watched so staff are paid and suppliers are not left waiting. Shelves must carry the medicines that matter most without tying up money in products that sit for months. Costs like rent and electricity creep up quickly, and if unchecked, margins vanish.
Strong supplier relationships also make a difference. Paying on time, negotiating fairly, and keeping that trust intact can protect a business when times are tough. And like any other retailer, pharmacy owners have to be careful about how much debt they take on. Too much, too soon, can put even a busy store under pressure.
When these basics are in place, a pharmacy is not just a trusted point of care. It is also a resilient business that can think about growing, instead of simply surviving.
Where funding helps
Growth always asks for money before it offers returns. Anyone who has opened a second branch, hired staff, or added delivery knows this reality. The bills arrive first, and only later does the revenue follow. For a small independent owner working on thin margins, that can feel like a brick wall.
This is also the point where funding can be an enabler rather than a burden. At Merchant Capital, we treat pharmacies like retail businesses because that is what they are. They need capital that moves quickly, without red tape, and repayment models that flex with real turnover rather than with a rigid schedule. That flexibility gives owners breathing space, the confidence to back their instinct, invest in a new outlet, upgrade systems, or respond to their community.
Looking ahead
Independent pharmacies have already shown how vital they are to South Africa’s healthcare system. The next step is ensuring more of them open in the areas where they are most needed. With sound business management and access to the right kind of funding, these enterprises can grow their footprint, create jobs, and continue to provide reliable access to healthcare.
As of September 2025, Aspen Pharmacare will undertake the distribution of selected Boehringer Ingelheim prescription medicines across South Africa. This partnership represents a significant step towards ensuring that more patients gain timely access to the treatments they need, helping improve health outcomes today and for generations to come.
“Our priority is always patients. Partnering with Aspen means we can bring our innovative medicines to people faster, addressing urgent needs in cardio-renal-metabolic and lung diseases as well as stroke. As a company, we focus on developing innovative therapies that can improve and extend lives in areas of high unmet medical need. Together, we are not only improving access today but also transforming the lives of future generations across South Africa,” says Dr Anthony Lauw, General Manager and Head of Human Pharma, Boehringer Ingelheim Southern Africa.
Commenting on the partnership, Heinz Schütte, Aspen Regional CEO South Africa Commercial said: “For us, this collaboration is about putting patients first. By leveraging our reach and expertise in South Africa, we can ensure that Boehringer Ingelheim’s innovative therapies are accessible to more people, when and where they need them. This is an important milestone in our ongoing mission to improve health outcomes across the country.”
Boehringer Ingelheim, an independent and family-owned company, takes a long-term view of healthcare, investing heavily in research and development to deliver innovative therapies that address unmet medical needs.
This agreement was approved by the South African Competition Tribunal on 15 July 2025, following a recommendation from the Competition Commission.
A comprehensive five-year analysis of gap cover claims reveals a healthcare funding crisis that’s rapidly escalating across the South African private healthcare sector. Data from Sirago Underwriting Managers shows that its mega gap claims – those exceeding R50,000 – have exploded by 512% in volume and 437% in value between 2020 and 2024.
The numbers tell a stark story: where 89 mega gap claims totalling R6.2 million were paid in 2020, this figure rocketed to 549 claims worth R34 million in 2024. Perhaps most concerning is that claims exceeding R60 000 are now daily occurrences, with the average large loss gap claim sitting at R63 000 – a far cry from the R6000 to R12 000 averages seen pre-2020.
The Perfect Storm: Medical Scheme Erosion Meets Provider Cost Inflation
This upward trajectory reflects a fundamental shift in South Africa’s healthcare landscape. Medical schemes – constrained by affordability, access, aging membership populations, and where private healthcare already consumes up to 20% of household income – are systematically reducing benefits and transferring more risk onto the member, rather than increasing premiums to match out-of-control healthcare provider cost inflation.
Healthcare provider costs have consistently outpaced inflation by more than double for years, yet unlike pharmaceuticals, there’s no pricing regulation on healthcare provider tariffs. In a country facing a dire shortage of healthcare professionals, specialists are free to charge rates often 500%+ higher than medical scheme reimbursements.
The regulatory framework compounds this issue. The Registrar of Medical Schemes mandates that for Prescribed Minimum Benefit (PMB) conditions, where no Designated Service Provider agreement exists, healthcare providers must be paid in full regardless of the charge – essentially providing a blank check.
Breaking Down Sirago’s Large Loss (Mega) Gap Claims Data (2020-2024)
Five-Year Trend Analysis
2021: 118% increase in claims value paid compared to 2020, driven by COVID-19 impacts and deferred elective surgeries.
2022-2024: Average annual increase of 35% year-on-year in large loss claims volumes.
Highest claims: R200,000+ for ischaemic heart disease conditions in the 50+ age group.
Age Demographics Challenge Assumptions
Contrary to expectations, healthcare crises aren’t limited to older populations:
50-65 years: 31% of claims (average: R65,065)
66-75 years: 27% of claims (average: R64,213)
76+ years: 18% of claims (average: R62,773)
30-49 years: 18% of claims (average: R58,116)
0-29 years: 5% of claims (average: R63,360)
The under-49 age group constitutes 23% of all large loss claims, dispelling notions that major health expenses only affect older demographics, and which highlights the risk transfer challenges faced and imposed by medical schemes.
Claims Distribution
62%: R40,000-R60,000
30%: R61,000-R100,000
6%: R101,000-R150,000
2%: R151,000-R210,000
Leading Conditions Driving Claims
Musculoskeletal Dominance
Over 51% of claims across all age groups involve musculoskeletal conditions, with spinal stenosis leading the charge. Medical schemes often impose strict limits on elective musculoskeletal surgeries due to high costs, particularly for internal prosthetics where co-payments can reach 30% of the hospital account if members don’t subscribe to the scheme-imposed protocols.
Cancer and Circulatory Conditions
Each representing 10% of large loss claims, these conditions reflect both the effect from the delayed diagnosis impact of COVID-19 and the high-cost nature of specialised treatments. Malignant neoplasms of the breast, prostate, and colon lead cancer claims, while acute ischaemic heart disease dominates circulatory conditions.
The Exploitation Factor
Gap insurance is increasingly becoming a target for exploitation. Healthcare providers now routinely ask patients upfront about gap coverage before determining charges, creating a troubling paradox where a R700 monthly gap policy might pay R130,000 for an orthopaedic surgery shortfall, while the medical scheme with an R8,000 monthly premium pays just R30,000. This exploitation threatens the sustainability of gap insurance itself. If current trends continue, gap insurance premiums will inevitably rise, making this crucial protection unaffordable for many South Africans.
The Critical Importance of Gap Cover
Despite these challenges, gap cover remains essential, irrespective of medical scheme option. Most medical schemes have deductibles, co-payments, and reimbursement limits that can leave members significantly out of pocket. The gap between scheme payments and specialist charges can be substantial – often 200% to 500% above scheme tariffs and this isn’t limited to basic hospital cover options. Even comprehensive, top-tier medical scheme benefits leave members facing substantial tariff shortfalls for in-hospital procedures.
The Economics of Healthcare Financial Protection
When you consider the potential financial quantum of a shortfall on your medical scheme benefits, and that a gap cover premium is around R700 per month for a family (2025 Sirago Ultimate Gap), and each family member is covered for up to a maximum of R213 000 per annum, it is clear that Gap Cover is a non-negotiable part of your healthcare financing strategy. A single gap claim of R63k, Sirago’s average large loss claim, would be the equivalent of almost 9 years of premium payments at current premium rates.
Sirago’s mega claims data reveals a private healthcare funding system under severe strain. As medical schemes transfer more financial risk to members through tariff shortfalls, co-payments, and exclusions, gap insurance becomes not just “a-nice-to-have” insurance policy, but essential for financial protection.
However, the sustainability of this model depends on addressing the root causes: unregulated provider pricing, systematic benefit erosion, and the exploitation of gap insurance by unscrupulous providers. Without intervention, South Africa’s healthcare funding crisis will continue to deepen, leaving patients to bear an ever-increasing financial burden.
For consumers, the message is clear: always negotiate pricing for planned surgeries and request formal quotes from all medical role players. In a system where healthcare providers are price makers and medical schemes and gap providers are price-takers, informed patient advocacy becomes crucial for financial survival and your continued access to quality private healthcare.
(Claims statistics drawn from Sirago’s Large Loss Claims Analysis, 2020-2025)
Sirago Underwriting Managers (Pty) Ltd is an Authorised Financial Services Provider (FSP: 4710) underwritten by GENRIC Insurance Company Limited (FSP: 43638). GENRIC is an authorised Financial Services Provider and licensed non-life Insurer and a member of the Old Mutual Group.
Note: The content of this article does not constitute financial advice. Sirago Gap cover is subject to terms and conditions and premiums are reviewed annually. For more information go to www.sirago.co.za (Ts & Cs apply).
Sanofi has reaffirmed its commitment to South African healthcare with the appointment of two senior leaders and a renewed focus on supporting healthcare professionals, expanding local partnerships, and improving access to essential treatments in key areas such as vaccines, immunology, and rare diseases.
“This is a new chapter for Sanofi in South Africa,” says Jean-Baptiste Bregeon, Sanofi South Africa’s Country Lead and Head of Vaccines. “We are focused on making a real impact through practical support for healthcare professionals, expanding access to important medicines and vaccines, and strengthening our ties with partners across the system.”
Focused leadership
Bregeon brings over 20 years of international experience, with senior roles in commercial and clinical operations across the Middle East, North Africa, and Eurasia. As former General Manager for North Africa at Sanofi Vaccines, he led efforts to improve vaccine access and build local capacity. He has also advised Sanofi’s global leadership on operational strategy and commercial planning.
Bregeon will oversee Sanofi’s overall strategy in the country and lead its vaccine division, which remains a core part of the company’s healthcare offering.
Lenisha Maharaj, newly appointed Head of Pharma for South Africa, Namibia and Botswana, is a seasoned Pharmaceutical Executive with over 20 years’ experience in the pharmaceutical and healthcare sectors. At Sanofi, she will oversee growth across the general medicines and specialty care portfolios, supporting both primary and specialist care.
“Sanofi understands the realities that healthcare professionals face,” says Maharaj. “Our goal is to support them with the right tools, training, and access to innovative treatments so they can keep delivering high-quality care.”
Strengthening partnerships and access
A key part of Sanofi’s long-term strategy is to build strong, lasting partnerships. Its collaboration with Biovac, a local vaccine manufacturer, is a core example. This will help to boost domestic vaccine production capacity and reduce reliance on global supply chains. Such public-private partnerships support healthcare resilience as well as local economic and scientific development.
Beyond vaccines, Sanofi is investing in other areas that have a direct impact on healthcare professionals and the patients they serve:
Clinical trials in South Africa: Expanding its local clinical research footprint to increase representation of African patients in global trials and ensure that treatment decisions are informed by local data.
Access to innovative medicines: Working to bring advanced treatments in rare diseases and immunology to South Africa, along with patient support programmes and diagnostic assistance, to help doctors and patients navigate access challenges.
Medical education and digital engagement: Offering CPD-accredited education, clinical webinars, and digital tools to help healthcare professionals stay updated on the latest treatment protocols and deliver more streamlined care.
Policy engagement and system support: Actively involved in discussions with policymakers and funders to help shape health policies that improve medicine access and promote fair, sustainable healthcare.
Supporting healthcare professionals
Sanofi says it recognises the ongoing pressures facing South African healthcare workers, from dealing with supply shortages and reimbursement hurdles to managing the growing burden of chronic and complex diseases.
“We see our role as being part of the solution,” says Bregeon. “We are here to support healthcare professionals, not only by ensuring a reliable supply of medicines, but by providing the training, tools, and partnerships they need to do their jobs effectively.”
The company is also prioritising engagement with healthcare professionals through regular updates, field team support, and opportunities for joint problem-solving around system-level challenges.
Sanofi says it is committed to staying in close conversation with the healthcare community and building a more resilient, inclusive, and patient-focused system.
“We want to work with doctors, nurses, pharmacists, policymakers and funders to build something long-term,” Bregeon adds. “We believe that by working together, we can improve outcomes for patients and strengthen the foundation of healthcare in this country.”
By James White, Director of Sales and Marketing at Turnberry Management Risk Solutions
Photo by Alex Green on Unsplash
Rising medical costs can be a major burden that negatively affects employees’ health, wellness and productivity. Even with medical aid in place, unexpected shortfalls for hospital stays, surgeries and specialist treatments can run into tens of thousands of Rands – creating financial stress that spills over into the workplace.
Group gap cover offers an affordable, accessible and highly effective way to bridge the growing divide between what medical schemes pay and what private healthcare actually costs. This makes a tangible difference for both employers and their employees.
A practical solution for reducing stress and improving productivity
Medical expense shortfalls can add up to significant amounts of money and can be enough to seriously impact an individual’s financial wellbeing. Employees who cannot afford the co-payments or gaps in cover may delay treatment, manage ongoing pain with temporary measures, or fall back on high-interest loans, all of which can negatively affect their focus and performance at work.
Group gap cover can help to prevent this type of scenario. Cover includes medical expense shortfalls, co-payments, and sub-limits, and some providers also offer value-added benefits like casualty cover, trauma counselling or additional cancer cover, depending on the plan.
This allows employees to access the care they need without having to worry about paying large sums of money out of their own pocket. It helps them get treatment sooner, making it more likely they will recover faster and return to work sooner, as well as offering improved peace of mind. All of this benefits the business as much as the individual.
Empowering brokers to support a broader wellness strategy
Brokers are ideally placed to support employers in designing employee benefits that do more than tick boxes by positioning group gap cover as an essential component of an organisation’s wellness strategy.
It is, however, essential to tailor group gap cover plans to align with the medical aid options that are already in place. The key is to create solutions that fit the needs of the organisation and its employees and add tangible value, taking into account elements like demographics, income bracket, life stage and so on. For brokers, this is an opportunity to drive innovation in employee benefits and demonstrate deeper advisory value.
Affordability that matters in a tough economy
As medical inflation continues to outpace the Consumer Price Index (CPI), comprehensive medical aid has become less attainable for many companies and their employees. Some organisations have been forced to downgrade their medical scheme contributions, leaving employees more exposed to shortfalls. Group gap cover offers a cost-effective way to mitigate that risk.
With preferential premiums, favourable underwriting terms, and often no waiting periods, group gap cover is cost-effective and affordable, especially when compared to the costs of upgrading a comprehensive medical aid plan that will typically also experience certain shortfalls. It is also tax efficient as a payroll deduction and can be implemented with minimal administrative burden.
Attracting and retaining talent in a competitive market
Today’s job seekers are looking for more than a payslip. They want to feel valued and supported. Offering group gap cover as part of a holistic benefits package can set a company apart, especially in sectors where high turnover is common.
Candidates take note when employers show they care about more than just performance metrics. A company that helps its people avoid financial distress during a medical emergency is a company that builds loyalty, trust and long-term engagement. Gap cover is an investment in human capital that pays dividends far beyond the balance sheet.
Genuine benefits build genuine loyalty
Medical costs are rising, and economic pressures are continually increasing. In such an environment, employers need benefits that do more than look good on paper – they need to add real value to the lives of their employees. Group gap cover is one of the most practical, cost-effective ways to support employees’ health and financial wellbeing while also protecting business performance.
By helping people access the treatment they need without incurring crippling debt, it reduces stress, shortens recovery time and fosters loyalty. For businesses looking to attract and retain talent, boost productivity and show genuine care for their people, group gap cover is a benefit that makes a real and lasting difference.
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.
The health insurance sector is undergoing significant changes that insurers, healthcare professionals and brokers need to be aware of. For one, healthcare costs have risen above the national inflation rate, forcing individuals and corporate entities to reassess their healthcare management strategies.
The industry is moving towards a more personalised and customer -focused approach, companies are revolutionising traditional insurance processes with digital platforms that offer simplicity, transparency and efficiency. The role of technology and data are driving forces behind these trends. With technological advancements reshaping health insurance, other trends like shifting demographics, an ageing population, and rising chronic diseases add complexity. Navigating this landscape requires specialised knowledge. This is where health insurance brokers become essential partners for companies in need of top-quality healthcare solutions for their workforce.
Shifting patterns in the health insurance market
The health insurance industry is currently experiencing significant changes driven by various factors. Healthcare expenditures and utilisation have increased dramatically in recent years given the prevailing South African economic climate and rising healthcare costs. Organisations are scrutinising their healthcare programmes, including those that provide cover for employees. Many employers are now adopting a hybrid approach that includes both medical scheme membership and health insurance to offer maximum flexibility and choice to their workers.
The healthcare sector is also witnessing an increasing adoption of digital solutions; mobile applications with online portals for accessing benefits and services. Users can take advantage of virtual healthcare solutions, such as telemedicine consultations and online appointment scheduling, which not only reduce costs but also save time. Consequently, brokers are focusing on partnering with insurers who offer technologically advanced and user-friendly digital services.
Challenges faced in the market
The health insurance market is facing several challenges. A significant hurdle is the issue of member education. There is a widespread misconception that health insurance operates in the same manner as medical scheme cover, leading to confusion and disappointment among members. Brokers play a crucial role by clarifying the distinctions between each type of cover, and they conduct annual assessment sessions to keep clients informed about new developments or available improvements. Frequent engagements that elucidate various aspects of their benefits empower clients to make more informed decisions.
The healthcare distribution system introduces another layer of complexity as it plays a critical role in ensuring the safe and efficient delivery of healthcare products to patients and healthcare providers. South Africa’s market comprises both public and private sectors, making it difficult to identify and reach the ideal target audience. The insurance sector is heavily competitive, characterised by numerous insurers, each offering a wide range of products. These challenges are compounded by regulatory bodies, stringent rules and requirements that organisations must navigate while attempting to earn customer trust.
Financial pressures significantly impact clients’ decisions regarding attaining affordable healthcare. Financial limitations forces clients to make difficult choices often prioritising essential expenses and, leading many to opt for cheaper health insurance plans even if they have higher out-of-pocket costs or limited cover. Clients who are struggling financially need guidance and sound advice in exploring their options for affordable solutions. By reviewing their existing healthcare costs and assessing their current cover, brokers and insurers can help recommend a more effective healthcare solution that suits their needs. Clients can also consult with a financial advisor to help create a budget that incorporate healthcare costs that includes an emergency fund to cover unexpected additional medical expenses.
The value of consulting health insurance brokers
Given these complexities, one may question why companies should consult health insurance brokers. The answer lies in their expertise and advocacy. Brokers possess in-depth market knowledge and understand insurance products, enabling them to devise tailored solutions that precisely meet the requirements of both companies and employees. They represent their clients in negotiations, ensuring regulatory compliance and striving to secure the best rates and terms while providing ongoing support.
Strategic partnerships: selecting the right insurer
Choosing the right insurance partner is crucial, and brokers focus on several key attributes during this selection process. The insurance company must exhibit sound financial health, offer a comprehensive suite of products and services, and maintain effective claims procedures alongside superior customer care. Additionally, brokers seek partners that demonstrate a commitment to technology and innovation as a means of enhancing the customer experience.
Also, in today’s landscape, an insurance company’s reputation is of paramount importance, as policyholders can easily access customer feedback on social media.
Enhancing the South African healthcare system
The South African healthcare system requires careful navigation. With the assistance of informed and professional brokers, companies can tackle prevailing issues, optimise their healthcare expenditure, and deliver valuable benefits to their employees, ultimately resulting in a healthier and more productive workforce. Brokers serve not only as a source for insurance products but also as providers of expertise and trust, acting on behalf of the client in a complex and dynamic environment.
Access to affordable, quality healthcare in South Africa is a challenge for millions of people. Medical aid is out of reach for low-income earners, and while initiatives like the Low-Cost Benefit Option (LCBO) and the National Health Insurance (NHI) have been proposed, complexity has caused many delays in their implementation. As a result, the Demarcation Exemption Framework was introduced to help bridge the gap, which allows certain insurance products that technically fall under the definition of a medical scheme to operate outside of the Medical Schemes Act.
While it was originally set to expire on 31 March 2025, the Exemption Renewal Framework was recently extended for another two years to 31 March 2027. South Africans can continue to access cost-effective primary healthcare solutions, but in this shifting landscape, brokers play a vital role in guiding their clients toward the best solutions for their needs and budget.
Addressing the healthcare coverage gap
The proposed LCBO framework aims to provide affordable, regulated primary healthcare coverage to lower-income South Africans. It was designed to address the gap between expensive medical aid plans and basic healthcare needs so that more people have access to essential medical services. Unfortunately, it has faced continuous delays, partly because of challenges with integrating it into the NHI. At the same time, the NHI is still a work in progress, and there is no clear timeline for its implementation.
“While South Africa’s regulatory frameworks evolve and have the worthy goal of providing healthcare access to all, the reality is that people need access to affordable primary healthcare solutions today. The extension of the Demarcation Regulations is an important step. It means people can continue to receive the healthcare services they need, like GP consultations, chronic medication, basic health screenings and more, while the challenges with LCBO and NHI are resolved. It also means health insurance providers and brokers can carry on improving affordability and access with innovative product offerings,” says Reo Botes, Managing Executive of Essential Employee Benefits.
Solutions for the now
Under the Demarcation Exemption Framework there are many innovative primary healthcare insurance products that act as a bridge while LCBO and NHI are still being developed. They are by no means a replacement for medical schemes, but they play a very important role in helping people mitigate primary health risks.
“By giving you access to affordable and flexible cover for day-to-day medical expenses, healthcare insurance can provide protection from unexpected medical costs, giving you peace of mind to focus on your health, rather than worrying about bills,” says Len Deacon, head of the health division at Lion of Africa Life Assurance “These products also often cover preventative care, like vaccinations, screenings, and check-ups, which can help detect and prevent illnesses early on. The upshot is that they can improve health outcomes by allowing people to seek treatment without worrying about the financial impact, potentially preventing more serious problems down the line.”
Navigating the uncertainty
When or if LCBO will come to fruition is not clear, and the timeline for the implementation of the NHI remains uncertain. The role of brokers is more important than ever in helping clients to understand their options, simplify processes and find the right cover for their needs during these times. Brokers assess individual needs, compare plans, provide expert advice, and assist with ongoing support, claims, policy adjustments and more.
While we wait for industry reforms to take effect, primary healthcare insurance options offer exceptional value and a variety of products to protect financial and physical wellbeing. The expertise of brokers is invaluable in helping clients to secure affordable and effective primary healthcare that works for now and in navigating this changing landscape in the future.
