Public Healthcare and Private Healthcare Explained

By the end of this guide, you should understand:

• What public healthcare is.
• What private healthcare is.
• How public healthcare is funded.
• How private healthcare may be funded.
• How access to healthcare can differ between the two systems.
• Why having medical aid is not the same as using private healthcare.
• Why public and private healthcare should not simply be described as “free” versus “paid”.

South Africa’s public healthcare system provides healthcare through government-funded healthcare services and facilities.

These include:

• public clinics;
• community health centres;
• district hospitals;
• regional hospitals;
• tertiary and specialised hospitals; and
• other public healthcare services.

The public healthcare system provides services ranging from primary and preventive healthcare to emergency treatment, maternity services, chronic healthcare, surgery and highly specialised hospital treatment.

Public healthcare is mainly funded by government through taxes and public budgets.

This means that patients do not necessarily pay the full cost of the healthcare they receive.

However, it is important not to describe all public healthcare simply as “free healthcare.”

Whether a patient is required to pay, and how much they may be required to pay, can depend on the healthcare service, the patient’s circumstances and the applicable public healthcare rules.

Different levels of the public healthcare system provide different types of healthcare.

For many non-emergency healthcare needs, a local clinic or community health centre may be the first point of contact.

Where additional treatment is required, a patient may be referred to another healthcare facility or to a higher level of care.

This referral process helps direct patients to the level of healthcare appropriate for their needs.

Emergency healthcare is different.

South Africa’s Constitution states that no one may be refused emergency medical treatment.

This right is extremely important, but there is an equally important distinction to understand:

The right to receive emergency medical treatment and the question of who ultimately pays for that treatment are not necessarily the same thing.

We will explore emergency healthcare and payment responsibilities in a separate Curalern guide.

As explained in MG001 – How Healthcare Works in South Africa, private healthcare is provided through privately operated healthcare professionals and facilities, such as doctors, specialists, pharmacies, clinics and private hospitals.

Private healthcare professionals and facilities generally charge for the services they provide.

These costs may be funded through a medical scheme (medical aid), an applicable health insurance benefit, self-payment or a combination of funding arrangements.

An important distinction is that using private healthcare does not automatically mean that you have medical aid.

You can use a private healthcare provider and pay for the healthcare yourself.

This is an important distinction.

Private healthcare describes healthcare services provided privately.

Medical aid describes a way of funding healthcare through membership of a registered medical scheme.

They are connected, but they are not the same thing.

A private doctor or hospital provides healthcare.

A medical scheme provides healthcare funding according to the law and its registered rules.

Even when someone belongs to a medical scheme, the scheme does not necessarily pay every amount charged by every private healthcare provider.

What the medical scheme pays may depend on factors such as the member’s benefit option, the healthcare service received, applicable tariffs, provider networks, authorisation requirements, benefit limits and other scheme rules.

These subjects will be explained individually in later Curalern guides.

Yes. Belonging to a medical scheme does not, by itself, prevent someone from receiving healthcare through the public healthcare system.

However, this does not necessarily mean that the person’s treatment will be provided free of charge.

Public healthcare facilities may classify patients differently depending on their circumstances and the applicable patient-fee rules. Medical-scheme membership may also be relevant to how an account is handled.

The exact position can depend on the healthcare facility, province, treatment and circumstances involved.

For now, the important point to remember is:

Having medical aid does not automatically prevent you from using public healthcare.

The rules surrounding public healthcare fees and medical-scheme patients can become more detailed, so we will explore them separately rather than trying to cover every possible situation here.

Public and private healthcare are both parts of South Africa’s wider healthcare system.

The table below highlights some of the main differences.

There is no single answer that applies to every person or every healthcare situation.

Where someone receives healthcare may depend on factors such as:

• the healthcare service they need;
• whether the situation is an emergency;
• where they live;
• what healthcare services are available nearby;
• whether they belong to a medical scheme;
• whether they have relevant health insurance benefits;
• what they can afford to pay themselves;
• provider or facility availability; and
• the rules of their particular funding arrangement.

Understanding these factors is more useful than simply thinking of the healthcare system as “public versus private.”

The important question is not only:

“Where can I receive healthcare?”

It is also:

“How will the healthcare I receive be funded?”

The most important ideas are:

• South Africa has both public and private healthcare.
• Public healthcare is mainly funded by government through taxes and public budgets.
• Public healthcare should not automatically be described as free for everyone.
• Private healthcare is provided through privately operated healthcare professionals and facilities.
• Private healthcare can be funded through medical schemes, applicable health insurance benefits, self-payment or other arrangements.
• Using private healthcare does not mean that you must have medical aid.
• Having medical aid does not automatically prevent you from using public healthcare.
• Emergency access to healthcare and responsibility for paying an account are separate questions.
• Public/private healthcare and healthcare funding are related, but they are not the same thing.

Now that you understand the basic difference between public and private healthcare, the next step is to look more closely at one of South Africa’s most important forms of healthcare funding:

We will look at what a medical scheme actually is, how membership works, why members pay contributions and what the law requires medical schemes to provide.

We’ll take it one step at a time.