Category: Medical Industry

Categories : Expert Opinion Medical IndustryTags :

The Future of Pharmacies in South Africa Lies in Sustainable Expansion

On By ModernMedia
Photo by National Cancer Institute on Unsplash

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.

Categories : Medical IndustryTags :

Boehringer Ingelheim and Aspen Pharmacare Announce New Partnership to Bring Treatments Closer to Patients in South Africa

On By ModernMedia
Photo by Khwanchai Phanthong on Pexels

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.

Categories : Expert Opinion Medical IndustryTags :

The Healthcare Financing Crisis and the Impact on Gap Cover

On By ModernMedia

A Five-Year Analysis of South Africa’s Healthcare Funding Challenge

Photo by Scott Graham on Unsplash

Mega Gap Claims Surge Reveals Private Healthcare System Under Cost Pressure

Opinion by Martin Rimmer, CEO of Sirago Underwriting Managers

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).

Categories : Medical IndustryTags :

Sanofi Steps up Investment in SA Healthcare with New Leadership and Stronger Local Partnerships

On By ModernMedia
Photo by Sora Shimazaki

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.”

Categories : Expert Opinion Medical IndustryTags :

Opinion Piece: Why Employee Benefits Need to Go Beyond Medical Aid

On By ModernMedia

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.

Categories : Expert Opinion Medical IndustryTags :

Opinion Piece: Rewriting the Rules of Health Insurance

On By ModernMedia

By Shaun Raizenberg, Employee Benefits Consultant at Essential Employee Benefits

Photo by Scott Graham on Unsplash

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.

Categories : Medical IndustryTags :

Healthcare is Expensive – but There are Affordable Alternatives

On By ModernMedia
Photo by Towfiqu barbhuiya on Unsplash

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.

Categories : Expert Opinion Medical IndustryTags :

SA Healthcare: Primary Care is Key

On By ModernMedia
Lungile Kasapato, Chief Executive Officer of PPO Serve

The South African commercial health sector is at a critical juncture, grappling with a severe imbalance that threatens its sustainability and the accessibility of quality care. The dominance of the hospital sector and the deficient state of primary care, are creating an unsustainable system that demands urgent reform, says Chief Executive Officer of PPO Serve, Lungile Kasapato, speaking at the Board of Healthcare Funders (BHF) conference, held in Cape Town from 10-14 May.

“Primary care in the South African commercial health sector is underpowered, compared with a dominant hospital sector, that is pulling the system off-kilter, as a consequence,” Kasapato said.

She identifies a weak and disjointed primary care system as a key driver of this imbalance, underfunded by limited out of hospital benefits and exacerbated by the fee-for-service payment model, which incentivises fragmented care and counterproductive competition. This model leads to GPs competing with specialists for limited out-of-hospital benefits, hindering the collaborative approach needed for optimal patient outcomes.

“Incentives exist to deliver high volumes of covered services, rather than those which will produce the best outcomes and value,” she explains, highlighting the misalignment of financial incentives that the patient, and the medical scheme, needs.  

The problem is further compounded by managed care models, which Kasapato suggests can inappropriately shift clinical accountability to funders who lack direct patient interaction. She is also wary of the conflicting roles of scheme administrators, who can profit from being both payers and providers, undermining the “not for profit” ethos of medical schemes and stifling innovation.  

Kasapato stresses the crucial role of payers in strategically purchasing care from professionals working in multidisciplinary care teams. By doing so, payers foster healthy competition among these teams, with performance measured by outcomes and efficiency. She points to the contracting model between Government Employees Medical Scheme (GEMS) and PPO Serve’s The Value Care Team as an example, which involves a monthly global fee, adjusted for patient risk. Significant additional fees are linked to performance.  

The effectiveness of this approach has been demonstrated in a three-year pilot with GEMS, which resulted in a 29.6% reduction in medical admissions and a 7% decrease in patient bed days, along with a 39% increase in flu vaccine uptake amongst at-risk patients. “That’s not just better care – it’s better use of every rand spent,” she said, highlighting the financial benefits of improved care co-ordination.  

Kasapato proposes a fundamental shift towards healthy partnerships built around multidisciplinary GP-led teams. This is the approach of The Value Care Team, which emphasises co-ordinated care delivery. In this approach, clinical teams, allied health workers, alternative care facilities, and community-based organisations are integrated, with care co-ordinators guiding patients through the system. This structure aims to reduce waste, minimise unnecessary hospitalisations, and prioritise preventative care.

“Teams work together to deliver quality, efficient care within local resources, including collaboration with allied health workers, alternative care facilities and community-based organisations,” explains Kasapato.

Looking ahead, Kasapato stresses the urgency of addressing unhealthy competition and rebalancing the system to ensure long-term sustainability and progress towards universal healthcare. She cautions against short-sighted solutions like discounted fee-for-service networks and scheme-led managed care, which offer only temporary relief.

“After decades of imbalance, we’ve found ourselves in a situation where the vast majority of people living in South Africa cannot afford to access our badly structured healthcare resources,” says Kasapato.

Instead of sustaining a flawed system with solutions like isolated telehealth and pharmacy nurse clinics, Kasapato is calling for a fundamental transformation; “Let’s stop propping up a system in need of transformation and focus our efforts on partnerships that strengthen primary care delivery, bringing it into balance with hospital-based care and addressing the major challenges that the commercial sector is facing.”

Categories : Expert Opinion Medical IndustryTags :

Opinion Piece: U.S. Funding Halted, Futures at Stake

On By ModernMedia

Finding a path forward for South Africa’s healthcare workers

Donald McMillan

By Donald McMillan, Managing Director at Allmed Healthcare Professionals

06 May 2025

South Africa’s healthcare system is under serious pressure. The sudden suspension of critical US funding has resulted in the loss of around 15 000 healthcare jobs – many of them linked to HIV/AIDS programmes that served as lifelines for vulnerable communities. Combined with broader public sector budget cuts and a national hiring freeze, the situation threatens to undo decades of progress in healthcare delivery. As public hospitals struggle with fewer staff and shrinking resources, the country is at risk of losing not only jobs, but skills, infrastructure, and hope. But in the face of these challenges, there are still ways to keep services running and people employed. One of them is through Temporary Employment Services (TES), which provides a flexible staffing approach that can help stabilise the system while longer-term solutions are explored.

A healthcare system under pressure

The US aid cut has had an immediate and devastating impact. Programmes focused on HIV, tuberculosis, and reproductive health, many of which were propped up by international donor funding, have been forced to scale back or shut down entirely. Thousands of community healthcare workers, nurses, counsellors, and administrators have found themselves jobless, while patients are left facing longer wait times and reduced access to care.

At the same time, cost-cutting across the public sector has put a freeze on new hires, even in essential departments like health and the impact is already being felt. With public hospitals and clinics stretched thin, they’re unable to take on newly trained doctors and nurses. And while the private sector plays a role, it simply cannot absorb the overflow. This isn’t just a staffing issue, it’s a setback for the entire healthcare system, affecting everything from medical training to frontline care.

Young professionals left in limbo

Every year, South Africa produces thousands of highly trained doctors and healthcare workers, many of whom move into the public health system after completing their compulsory community service. These roles used to be a given but with hiring freezes and shrinking budgets, many young professionals are now finishing their training with nowhere to go. Despite their skills and frontline experience, these workers are left in limbo. This is a double blow as South Africa loses out on the return from its investment in their education, while the risk of a growing skills drain looms large. With countries like the UK, Australia, and Canada actively recruiting healthcare workers, there’s a real chance they may leave and not come back.

A flexible solution in Temporary Employment Services

In response to this crisis, temporary employment solutions have become a practical and effective solution. TES providers offer qualified healthcare professionals short- to medium-term flexible contracts, enabling them to continue working in their field while delivering essential support to overburdened healthcare facilities.

This approach offers a lifeline not just for displaced workers, but for clinics and hospitals struggling with limited resources. TES employees can be rapidly deployed where they are needed most, whether to cover staff shortages, serve remote communities, or support seasonal fluctuations in demand. Unlike permanent hires, they don’t carry long-term costs such as medical aid or pension contributions, making them a more budget-conscious option in uncertain times.

The benefits of the TES model have already been proven. During the COVID-19 pandemic, temporary staff played a key role in scaling up testing, vaccination, and treatment efforts across the sector. That same adaptability is needed now to respond to the healthcare funding crisis.

Rethinking the future of healthcare work

While temporary employment solutions cannot not solve the problem alone, it can provide an important stopgap and potentially a new way of thinking about workforce planning in the healthcare sector. Rather than relying solely on permanent positions, South Africa may need to adopt a more fluid, demand-based deployment model that allows professionals to move between roles, regions, and areas of urgent need.

Shifting to this model calls for a change in mindset. Permanent posts have traditionally been seen as the gold standard in healthcare, valued for their stability and benefits. But in a time of uncertainty, contract and locum roles – especially when managed by trusted TES providers – can offer a practical alternative, combining income, ongoing experience, and flexibility.

Retaining talent, restoring hope

Avoiding long-term damage to South Africa’s healthcare system will require urgent, coordinated action. Government departments must urgently reprioritise spending toward essential services like health and education. At the same time, private healthcare providers and staffing agencies must step up and work together to ensure that skilled professionals are not lost to the system or the country.

Despite the current turbulence, South Africa’s healthcare workers remain among the best trained and most resilient in the world and with the right support structures, including flexible employment options like TES, we can preserve our healthcare capacity and continue to serve those who need it most.

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Next Biosciences Marks 20 Years of Biotech Innovation

On By ModernMedia
Dr Yvonne Holt, Chief Medical Officer of Next Biosciences (left) with Kim Hulett, Founder and CEO of the company (right) celebrating 20 years of innovation and leadership in stem cell banking, genetic testing and regenerative medicine.

As Next Biosciences celebrates its 20th anniversary, the pioneering South African biotech company reflects on two decades of significant advancements in science and healthcare.

From its roots in medical innovation to its transformative contributions in regenerative medicine, genetic testing and wellness, Next Biosciences has not only shaped the local industry, but also positioned itself as a leader in Africa’s growing biotech sector.

Founded by Kim Hulett, an entrepreneur with a background in finance and technology, and Dr Yvonne Holt, the company has expanded its range of products and services that cover biologics, stem cells, exosomes, genetic testing, longevity and reproductive health.

“The journey of Next Biosciences has been about bringing cutting-edge science and technology to South Africa, and making advancements in health and wellness accessible,” says Dr Holt, Chief Medical Officer at the company. “Every innovation we develop is driven by our mission to positively impact people’s health with science, by transforming lives, improving health outcomes and shaping the future of medicine on the continent.”

With a team of 90, Next Biosciences stands as one of the country’s leading biotech innovators. Women make up 80% of the workforce, with 20% of them being scientists – underscoring the company’s strong commitment to diversity and inclusion. Their lab is accredited by the Association for the Advancement of Blood and Biotherapies (AABB) and ISO 13485 standards, a testament to their excellence in stem cell banking, cord blood services and other biotechnological advancements.

From its beginnings with Netcare, Next Biosciences’ focus on research and development has enabled the company to expand beyond local borders, bringing its innovative healthcare solutions to a wider audience. They now lead initiatives that support regenerative medicine with products like OptiSerum, a revolutionary umbilical cord blood serum for ophthalmic use, and AmnioMatrix, used in a range of medical applications from ophthalmology and wound care to dentistry.

Next Biosciences’ state-of-the-art Netcells storage lab, ensuring the safe preservation of precious stem cells for future medical advancements.

“Biotechnology and regenerative medicine are advancing at an unprecedented pace, offering new possibilities for treating diseases that were once thought incurable. Our focus remains on harnessing these innovations responsibly, ensuring that the latest advancements in cellular therapies, genetic diagnostics and biologics translate into real, life-changing solutions for patients,” says Dr Holt.

The biotechnology landscape has evolved worldwide, and South Africa has not been left behind.

Credit: Global Biotech Indus

The global biotechnology industry is currently valued at $546 billion, growing at approximately 13% per annum. Remarkable advancements have been achieved in genetic research, stem cell therapies and personalised medicine. “The potential for biotechnology over the next decade is extraordinary,” says Hulett, CEO of Next Biosciences. Breakthroughs in regenerative medicine and longevity science are revolutionising healthcare as we know it.”

Next Biosciences’ path hasn’t been without challenges. From navigating regulatory hurdles to sourcing cutting-edge technologies, the company’s growth has been driven by passion, resilience and innovation. As a majority female-led team, the company exemplifies the power of women in science and business, and they have become a beacon for female entrepreneurs looking to make a mark in the science and technology sectors.

“Building a biotech company in SA, with all its complexities, required tenacity and a relentless commitment to our mission. Over the years, we have witnessed our industry evolve and we are proud to have been at the forefront of that change,” says Hulett. “The future holds great promise and we are excited to see what the next 20 years will bring.”

Looking ahead, Next Biosciences aims to expand its footprint in Africa, focusing on reproductive, regenerative and longevity health to empower individuals to invest in their health and live their best lives. With a strong commitment to innovation, accessibility, convenience and sustainability, Next Biosciences plans to integrate cutting-edge biotechnologies, while maintaining a patient-centric approach. By staying at the forefront of the biotech industry, the company is set to strengthen its position as a trusted leader in African healthcare.