When Healing Hurts: South Africans Struggle with Soaring Doctor Fees
For many South Africans, accessing private healthcare is meant to provide security and peace of mind. But increasingly, patients are facing a harsh reality: life-saving treatment can come with crippling financial costs.
Financial experts warn that doctors are charging up to 500% above medical aid scheme rates, leaving patients with enormous out-of-pocket bills. Families are forced to take out gap cover policies to bridge the shortfall—or risk unmanageable debt.
A Crisis of Trust and Affordability
Sanjith Hannuman, a financial consultant and director at AVIB, described the situation as “a crisis of trust and affordability” in South Africa’s private healthcare system.
“Patients, already strained by high medical aid contributions, face a second, devastating financial blow: out-of-pocket payments for services billed at 200%, 300%, or even 500% above medical aid scheme rates,” Hannuman said.
Hannuman shared the story of a Gauteng man who faced an R85,000 shortfall after emergency spinal surgery, with the specialist billing 480% above the medical aid rate—a debt that could take years to repay.
“These are not anomalies but symptoms of a calculated business model,” Hannuman said. “The patient-centred approach, once the heart of healthcare, is being suffocated by profit.”
Legal Loopholes Fuel the Problem
The sharp rise in fees is partly due to a regulatory gap in South African law. The National Health Reference Price List (NHRPL), which previously provided benchmarks for medical fees, was declared invalid in 2010. Since then, healthcare providers can charge what they consider fair, constrained only by vague requirements to offer “fair value.”
“The Health Professions Council of South Africa mandates fees be ‘fair and reasonable,’ yet there is no mechanism to define or enforce what that means in practice,” Hannuman said.
The Council for Medical Schemes (CMS) acknowledges that co-payments are a leading driver of complaints and financial strain for medical aid members, highlighting the systemic nature of the problem.
Gap Cover: A Band-Aid on a Broken System
With specialist fees frequently exceeding scheme rates and co-payments growing, gap cover is increasingly essential. Brian Harris, general manager at Turnberry Management Risk Solutions, stressed its importance:
“Medical aid alone leaves gaps. Specialist fees, penalties for non-Designated Service Provider hospitals, and co-payments can be significant. Gap cover is now critical to protect families from financial ruin.”
A Durban-based doctor, speaking anonymously, confirmed the high costs:
“Out-of-pocket payments can be very high—sometimes 200% or more—so patients need to plan accordingly.”
Patients Bear the Brunt
The human toll of these fees is enormous. Hannuman pointed to emptied retirement savings, re-mortgaged homes, and psychological distress from unexpected “bill shock.”
“A life-threatening diagnosis followed by financial catastrophe shatters trust between doctor and patient. The system monetises vulnerability at its most acute moment,” he said.
Despite repeated requests, the South African Medical Association (SAMA) declined comment, pointing questions to CMS and the HPCSA, which also did not respond to repeated inquiries.
A Call for Reform
While doctors deserve fair compensation for their skill and risk, patients and financial experts argue that current charges are unsustainable and unregulated. Cases like the Gauteng man’s R85,000 bill are increasingly common, and without clear enforcement or guidance, families continue to face financial devastation when they need care most.
As private healthcare grows costlier, South Africans are left asking: when did life-saving treatment become a gamble with your savings?
Source: IOL
Featured Image: Pexels
