Kevin Aron, Principal Officer at Medshield Medical Scheme
Many South Africans may not give their medical scheme much thought on a daily basis. Instead, they tend to focus on it when the monthly payment is deducted, during announced increases, or while submitting a claim. However, the real importance of healthcare funding is revealed during unexpected life events, such as a severe accident, a cancer diagnosis, an emergency procedure, or the premature birth of a child. At such times, the primary concern shifts from cost to the ability to access required care, along with the assurance that necessary treatments will be funded, preventing financial strain.
Despite the benefits associated with artificial intelligence and digital innovation, I contend that the most pressing issue in healthcare today is the affordability of remaining on a medical scheme. If high-quality healthcare fails to remain attainable for the average South African, then even the most remarkable advancements will yield limited benefits.
Medshield’s 2027 offering emphasizes affordability, accessibility, and enhanced member support. We have managed to keep the average contribution increase at a reasonable 7.9%, with a significant portion of our members—125,603 experiencing increases capped at just 6% and 7%. Meanwhile, existing benefits have been safeguarded, selected limits on benefits have been raised, and co-payments have been reduced to ease out-of-pocket expenses. Furthermore, we now allow child dependants to remain covered until they turn 24.
South Africa’s healthcare landscape is increasingly intricate each year. Families are confronting escalating costs for necessities, while healthcare inflation consistently surpasses general consumer inflation. Rising hospital tariffs and medication prices, coupled with a surge in utilization stemming from chronic lifestyle diseases and a growing elder population, pose significant challenges. Medical schemes must retain adequate reserves to cater to members’ healthcare needs while ensuring that contributions remain affordable, all amidst these escalating costs. This tension is deepening the divide between the costs of providing healthcare and what families can afford.
Affordability encompasses more than just cost discussions. It informs benefit design, partnerships with providers, preventative measures, and the use of technology. The sector cannot perpetually rely on rising contributions to cover increasing costs; we must enhance healthcare delivery while ensuring that every rand works efficiently for members.
Healthcare funders and providers are increasingly encouraged to adopt a value-based reimbursement model. Instead of compensating healthcare providers based on services rendered (such as consultations or admissions), payments should be tied to outcomes. Enhancing healthcare doesn’t necessarily mean providing more treatment but rather assisting individuals in maintaining their health through prevention and coordinated care, which decreases the likelihood of expensive complications. This shift not only benefits members but also allows medical schemes to manage long-term expenditures more effectively. Our 2027 benefits reflect this approach through a revamped integrated chronic disease management program.
Collaborative partnerships have been a cornerstone of our philosophy at Medshield. Medical schemes must collaborate with healthcare providers, managed care organizations, the Council for Medical Schemes, healthcare administrators, and the members themselves. When members actively engage in preventative care and manage chronic conditions effectively, they not only enhance their health outcomes but also contribute toward a more sustainable healthcare system.
This concept extends beyond healthcare issues. Decisions about health do not occur in a vacuum, as individuals must balance them against various financial pressures, connecting health with overall financial wellness. Through a new agreement with Sanlam, we aim to provide our members and corporate clients with improved access to an extensive range of health and financial wellness solutions, including Sanlam Gap, Sanlam Reality, and Sanlam Wealth. This partnership allows us to broaden the dialogue and align healthcare solutions more closely with financial well-being.
Artificial intelligence, predictive analytics, and digital health platforms offer significant potential to identify at-risk members sooner, support preventative measures, enhance accessibility through virtual care, and optimize administrative tasks. When utilized properly, these technologies can enhance clinical outcomes and operational efficiency. However, their true worth is determined by their ability to make healthcare more accessible, personalized, and ultimately affordable. This aim will be a priority in 2027 as we roll out AI-supported diabetic retinal screening across all plans and increase home care access through partnerships with Quro and Mediclinic Hospital-at-Home.
Such advancements require solid governance and trust. Members already navigate complex benefit structures, tariffs, provider networks, and funding regulations that can be opaque. Therefore, technology should simplify this experience rather than complicate it. For 2027, we are offering members more engagement options: a seven-day WhatsApp service providing self-service solutions, an improved Medshield member app featuring emergency assistance, and the introduction of 19 more walk-in centers in addition to our seven existing regional offices. Importantly, transparency is key; members must understand what they pay for and what benefits to expect, as this builds confidence and empowers informed healthcare choices.
Ultimately, affordability, collaboration, innovation, and transparency hinge on long-term sustainability. A sustainable healthcare framework cannot be established through a single innovation or annual performance; it requires disciplined governance, mindful financial management, and a stable focus on providing value to members.
At Medshield, we recorded eleven consecutive months of net membership growth in 2025, with a 4.5% increase in principal membership while maintaining a solvency ratio of 53%, far above the statutory minimum. This positive trend has persisted into 2026, with ongoing net growth and an overall increase of 10%. This growth reflects a rising awareness among members regarding the expansive benefits and value gained through their contributions. Achieving such results in our industry is challenging, yet they underscore a broader point: sustainable growth is feasible when affordability, financial prudence, and member value are intertwined as priority objectives.
Innovation holds value only if it aids in building a healthcare system that is technologically advanced, financially accessible, and serves the needs of its users. The future will hinge on our ability to deliver quality healthcare efficiently, protect members in their most vulnerable moments, and ensure the sustainability of healthcare for generations ahead.
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