Relevance is the new currency in healthcare. It is no longer enough for medical schemes to balance reserves, manage claims and negotiate tariffs. In a country facing rising inequality, fragile productivity, and widening access gaps, the private sector will be judged not by what it protects, but by what it enables.
This is why the time has come for the medical scheme industry to adopt a broader organising framework — one that measures our value to society, not only our value to members.
Thinking beyond SDG 3.8
Right now, the debate around National Health Insurance has exposed an uncomfortable truth, which is that our health system is structurally misaligned with the outcomes South Africans care about most, namely, access, equity, and financial protection.
And unless the private sector intentionally repositions itself, it risks being seen as peripheral to the solution.
The United Nations Sustainable Development Goals (SDGs), especially SDG 3.8 on universal health coverage (UHC), offer a strategic framework that can anchor that repositioning.
The SDGs are not abstract ideals. They form the benchmark by which global progress is measured, and with just five years left to meet the 2030 targets, the world is far off track. That includes South Africa.
Despite important reforms, UHC remains elusive. For the private healthcare sector, this should not just be a government problem; it’s a shared responsibility.
Crucially, the sector must think beyond SDG 3.8.
A narrow focus on access to health services and financial protection alone risks missing the full opportunity to contribute to sustainable health outcomes.
Medical schemes can use all the SDGs to reframe relevance. Core financial metrics, including solvency, benefit richness, and utilisation, must remain, but they are not enough.
Poverty (SDG 1), inequality (SDG 10), and gender disparities (SDG 5) all shape how, and whether, people access healthcare.
If benefit design fails to address the real pressures facing members, such as cost, gender equity and geographic barriers, it fails the system.
More importantly, about 80% of health outcomes are influenced by social determinants of health — factors such as housing, employment, education, transport, and access to clean water and sanitation.
These are central to the broader SDGs. A scheme that supports clean water access or community sanitation contributes directly to better health, even if it doesn’t show up in a claims report.
Yet our regulatory frameworks don’t always allow for this kind of contribution to be recognised. That must change.
Medical schemes should be allowed, and encouraged, to explore interventions that straddle the line between health and development.
Supporting workplace wellness, funding health education and co-investing in sanitation infrastructure should not just be viewed as charitable add-ons. They are risk mitigation.
Dr Katlego Mothudi 16 Jul 2025 They are long-term cost containment. They are also necessary to make UHC real.
Health system of tomorrow
Economic growth and decent work (SDG 8) are just as critical. The stability of the private healthcare model depends on employment and employer subsidies.
As unemployment grows, so does scheme attrition. It’s in everyone’s interest to protect the formal economy and workforce well-being, not only as a social good, but as a financial imperative.
Equally, the growing focus on ESG (environmental, social, governance) performance globally means investors and regulators are watching.
Healthcare funding that ignores social impact will increasingly be seen as outdated, or worse, irresponsible. Medical schemes control a significant portion of health expenditure.
The way that money is deployed matters.
This is not about changing who we are as an industry. It’s about clarifying our purpose. If schemes are to thrive, they must be able to show that they enable healthier societies, not just richer benefits.
That means participating in system-level conversations, not waiting to be asked. It means having the data to track who is being left out and the will to design for them.
That also means actively measuring what matters, such as:
- How many young adults are priced out of cover?
- Are wellness incentives actually changing health behaviour?
- Do scheme benefits meet the needs of women, low-income members, or freelance workers?
- How are digital tools improving, not just digitising, access and outcomes?
We must also be honest that UHC won’t be realised through legislation alone. Nor can it be achieved through cost-cutting in isolation.
It requires a values shift, a metrics shift and a mindset shift.
By adopting the SDGs as a strategic lens, medical schemes can:
- Reassert their relevance in a reforming system.
- Strengthen their social licence to operate.
- Contribute to a healthier, more productive society.
The private sector has the capability, the data, and the innovation capacity to help shape a more equitable future.
But intent is no longer enough. The SDGs give us a map. The question is whether we will use it.
If our industry wants to influence the health system of tomorrow, we must start measuring ourselves against the outcomes that matter to the country, not just the outcomes that matter to our ledgers.
