The Healthcare System in South Africa

Understanding South Africa’s Healthcare System

With its vibrant culture, beautiful natural scenery, and attractive climate, it’s no wonder that South Africa is a popular destination for expats and tourists alike. But whether you’re visiting on vacation or planning to make it your home, it’s essential to understand how South Africa’s healthcare system works. That way, you can ensure your medical needs are met during your time in the country.

Fortunately for foreigners, South Africa is known for having some of the best hospitals and medical infrastructure in southern Africa. This is particularly true in major cities like Johannesburg, Cape Town, and Durban. These facilities attract patients from across Africa and beyond due to the high quality of care they offer.

However, South Africa’s healthcare system has its challenges. It ranks 49th out of 94 countries on the 2025 Global Healthcare Index. This suggests that while the country provides solid healthcare options, there is still significant room for improvement. This is particularly true when it comes to making public and private healthcare more equal.

To help you navigate the system, this article covers everything you need to know, including how to access medical care, the costs you can expect to pay, and more.

An Overview of Healthcare in South Africa

South Africa has a two-tier healthcare system, comprising a public system managed by the Department of Health and a private system operated by private providers, funded through private insurance and out-of-pocket payments.

South Africa has over 400 public hospitals. Provincial health departments manage large, regional hospitals, while local municipalities oversee smaller hospitals and primary care clinics.

The majority of the population (approximately 80%) relies on the public healthcare system for care. Although the government subsidizes this care, patients often have to cover some costs themselves. Unfortunately, the public healthcare system usually suffers from inadequate funding and poor management.

As a result, around 20% of the population opts for private healthcare, which offers higher quality care, shorter wait times, and more modern facilities.

However, because private healthcare can be expensive, it is mostly middle and upper-class South Africans who use it, as well as expats who can afford it.

Although you do not need coverage to access private healthcare in South Africa, it is highly advisable due to the high costs of out-of-pocket payments. Therefore, many people purchase a plan to help manage these expenses.

Healthcare Funding and Expenditure

According to the WHO’s Global Health Expenditure Database, South Africa allocates approximately 8.6% of its Gross Domestic Product (GDP) to healthcare, encompassing both public and private sectors. This is slightly above the global average of 7-8% of GDP.

South Africa’s public and private healthcare systems are funded by different sources, as outlined below:

Public Healthcare Funding

Most of the funding for South Africa’s public healthcare system comes from the government, which allocates money from national, provincial, and local budgets. This funding primarily comes from taxes.

Patients may also contribute through point-of-care payments. The system is also subsidized up to 40% through a scheme known as the Uniform Patient Fee Schedule (UPFS). This helps standardize and reduce costs for healthcare services.

The UPFS regulates patient billing and physician payments based on income and family size. The system categorizes patients into three billing groups.

• Full Paying: This applies to patients who use private physicians or are non-citizens. Expats who use public facilities fall into this category and have to pay the highest fees.
• Partially Subsidized: Patients in this group have their healthcare costs partially covered based on their income and family size.
• Fully Subsidized: This category generally includes pensioners and the unemployed, who receive full coverage for their medical costs.

Some medical services are free, such as those provided by nearly 3,500 clinics that offer free care to pregnant women and children under the age of six.

Despite these subsidies, the funds often do not cover all the needs of the public healthcare system. Patients might still incur small fees for certain services, although these fees are typically lower than those in the private sector.

Private Healthcare Funding

Private healthcare in South Africa is mainly funded through private health insurance. People and employers buy plans from various providers to cover medical services and treatments.

Patients can also pay directly for services out-of-pocket. This includes costs for doctor visits, treatments, hospital stays, and procedures.

Investments from private companies and individuals mainly fund private healthcare facilities in South Africa.

This allows them to offer high-quality services, advanced technology, and often shorter waiting times compared to public hospitals.

Challenges in South Africa’s Healthcare System

As mentioned, South Africa has some of the best healthcare facilities and professionals in the region. Large cities like Johannesburg and Cape Town are known for their excellent public hospitals.

Public hospitals associated with major universities also offer a high standard of care. However, due to high demand, waiting times at these institutions are notoriously long.

Public hospitals in South Africa often face issues of underfunding and understaffing. Around 80% of doctors work in the private sector, making it difficult for public hospitals to retain medical staff.

This results in prolonged waiting times, a lack of privacy, and severe overcrowding for patients.

There are also challenges related to accessibility. For instance, healthcare accessibility remains poor in rural areas. In addition, only an estimated 27% of patients who need mental health care receive it.

Private hospitals, on the other hand, offer a higher standard of care, better facilities, and shorter wait times. They also provide greater privacy and more comfort for patients.

South Africa’s private hospitals also have the country’s best doctors, as they can offer them higher wages and better benefits than public hospitals.

However, gaining access to private healthcare often requires paying significant out-of-pocket expenses or buying comprehensive coverage, which can be a barrier for some individuals.

Plans to Improve Healthcare in South Africa

There are plans to improve South Africa’s healthcare system. In early 2024, parliament signed the National Health Insurance (NHI) Bill into law.

The new law aims to make healthcare available to everyone in the country, regardless of their income, by providing free or low-cost healthcare services to all residents.

The NHI will be rolled out in stages, and its full implementation may take some time to complete. The estimated cost to set up the NHI is between $8.6 billion and $23.6 billion USD (approximately R156 billion to R450 billion). The government is working on how to fund this system without placing too much burden on taxpayers.

Until the NHI is entirely in place, most expats in South Africa use private healthcare and often rely on international health insurance to cover the costs.

Who Can Access South African Healthcare?

South Africa’s Constitution guarantees that everyone has access to healthcare services. This includes citizens, expats, refugees, and asylum seekers.

Citizens can utilize both public and private healthcare services. The government funds public services, while private care is accessible through insurance and direct payments.

Notably, refugees and asylum seekers are entitled to public healthcare services. This includes free antiretroviral treatment for HIV/AIDS, without needing a permit or South African ID.

Can Expats Access Public Healthcare in South Africa?

Expats living in South Africa also have access to public healthcare, with no requirements such as visas or residency status.

As long as they are legally residing in the country, they are eligible for public healthcare. Foreigners can also opt for private healthcare if they prefer and choose an international health insurance plan to cover the costs.

Can Visitors Access Public Healthcare in South Africa?

Tourists visiting South Africa are not eligible for free public healthcare. However, they can still access healthcare by paying for services directly out of pocket or through travel insurance, which may cover the costs.

Tourists should buy a plan that covers medical expenses, as many healthcare providers require proof of coverage before offering treatment.

How to Access South African Healthcare as an Expat or Visitor

Once you understand how South Africa’s healthcare system works, accessing treatment as an expat or visitor is relatively straightforward. Here are the key steps you need to follow:

The Registration Process

For Expats

To access public healthcare, visit your local clinic or hospital and complete a registration form. You will need to bring the following documents:

• A valid passport
• Proof of legal residency (e.g., residency permit, work visa, or permanent residence documentation)
• Proof of your local address (e.g., a utility bill or rental agreement)

If you choose to use private healthcare, you will need to register with a private doctor or facility and show proof of private coverage.

For Visitors

Visitors seeking public healthcare should also complete a registration form and provide the following documents:

• A valid passport
• Travel insurance that covers medical expenses
• Proof of address within South Africa (for extended stays)

After registration, you can typically start using public healthcare services immediately. However, be aware that wait times for certain treatments or specialist consultations may be longer due to high demand and limited resources.

How to Receive Emergency Treatment as an Expat or Visitor

Anyone in South Africa can receive emergency hospital care, regardless of whether they are an expatriate, a visitor, or a South African citizen. However, the process and costs may vary depending on your status and the type of healthcare facility you use.

What to Do in an Emergency in South Africa

If you need urgent medical attention, dial 10177 for ambulance services or 112 for general emergency services.

These numbers will connect you to emergency responders who can send help to your location. Alternatively, you can go directly to the nearest hospital with an emergency department.

Both public and private hospitals offer emergency care 24/7. However, if you visit a public hospital, you may experience longer wait times for non-critical issues.

Hospital Administration

Upon arrival at the hospital, please present your passport, along with any relevant travel or health insurance documents.

Foreigners living in South Africa will also need to provide proof of legal residency. You may also need to complete a registration form if you haven’t already done so.

The Cost of Emergency Treatment

The cost of emergency care depends on several factors, including whether you visit a public or private hospital.

Generally, emergency treatment at a public hospital is free or low-cost, although non-South Africans might have to pay fees.

In contrast, emergency care at private hospitals is usually more expensive. If you have coverage, it should cover most of the costs, but you may still need to pay co-pays or deductibles. Without coverage, you will be responsible for paying the full amount yourself, which can quickly add up.

Expats and visitors often need to pay for medical treatment upfront, especially if the hospital doesn’t accept direct billing.

If you have travel health insurance, you will typically need to pay for the treatment first and then seek reimbursement. Ensure you review your policy to understand what is covered and how to obtain reimbursement.

Again, having the right coverage is crucial to avoid high out-of-pocket expenses when accessing healthcare in South Africa.

How Much Does Healthcare Cost in South Africa?

Healthcare costs in South Africa vary widely depending on whether you use public or private services, the type of treatment you need, and whether you have health insurance.

Public healthcare is significantly more affordable due to heavy government subsidies. However, despite the lower costs, the quality of care and availability of resources can be inconsistent.

Below is a breakdown of healthcare costs in each sector.

Payment and Subsidies

In South Africa, several healthcare programs and subsidies are available to make healthcare more accessible and affordable for vulnerable groups in the country. Below is an overview of the main ones.

Low-Income Earners

Public clinics and hospitals offer free or low-cost primary healthcare services to low-income individuals. This includes essential services like vaccinations, maternal and child health services, and treatment for common illnesses.

In addition, the Health Department’s District Health Services (DHS) program focuses on improving access to healthcare in poorer areas by providing subsidized care and ensuring basic health services are available.

Children

The South African government provides free vaccinations to children through the Expanded Programme on Immunization (EPI). This covers vaccines for diseases such as measles, polio, and tuberculosis.

There are also specialized child health clinics that offer free or subsidized care for children. This includes developmental checks and treatment for common childhood conditions.

The Elderly

Public hospitals and clinics offer free or low-cost healthcare services tailored to the needs of elderly patients. This includes geriatric assessments and management of chronic conditions. The government may also subsidize or provide certain healthcare services and medications at a lower cost for seniors.

Students

Many universities provide healthcare services to their students, including primary care, mental health support, and preventive care, often at no additional cost. Furthermore, public schools often have health programs that provide basic health services and screenings to students.

Low-Income Families

The government offers subsidized or free essential medicines through the Central Chronic Medicine Dispensing and Distribution (CCMDD) program, which benefits low-income individuals with chronic conditions.

In some areas, community health workers provide basic healthcare services and support to low-income families, including education on health and wellness.

Stay Protected During Your South African Adventure!

South Africa is a fantastic destination full of adventure, whether you’re just visiting or planning to move there.

To ensure a smooth and enjoyable stay, it’s essential to understand how to access healthcare and have the right coverage in place. That way, you’ll be all set for a worry-free stay in this vibrant country!