South Africa’s medical schemes paid more than R259bn in healthcare benefits during 2024. Behind every Rand spent was a decision about how best to improve the health of more than nine million beneficiaries.
These decisions are becoming increasingly complex.
Healthcare costs continue to rise, driven by an ageing population, greater utilisation, chronic disease and advances in medicines and medical technology.
Every medical advance creates new possibilities for patients.
But it also raises a difficult question: how should we pay for it?
Imagine having R1m to spend on healthcare.
You could fund a preventive intervention that protects 1,000 children from serious illness.
Alternatively, you could fund an advanced treatment that significantly improves the life of one patient with a debilitating condition.
Which is the right decision?
For the patient needing treatment, the answer may seem obvious.
But for someone responsible for the health of an entire population, the decision looks different.
Funding one intervention inevitably means that those resources cannot be used elsewhere.
Governments, public health systems and medical schemes confront these choices every day.
Their funding models may differ, but all must balance growing healthcare needs against finite resources.
One way to approach this challenge is to ask not only, “What does this treatment cost?”, but also, “What health benefit will this investment create?”
This lies at the heart of Michael Porter’s work on value in healthcare.
The objective is neither simply to spend less nor to spend more.
Michael-John Damant 27 Jul 2026 It is to achieve the best possible health outcomes from the resources available.
In practice, this is difficult.
Healthcare is deeply personal and closely connected to questions of equity and social justice.
Funding decisions must therefore weigh clinical evidence, affordability, fairness and the potential benefit across the population.
Every healthcare system makes such choices.
Some use waiting lists.
Others rely on clinical guidelines, formularies, treatment protocols or defined benefit packages.
The mechanisms differ, but the reality is the same. No healthcare system has unlimited resources.
Some call this rationing. Others call it priority setting or resource allocation.
Whatever the term, the challenge remains: how do we improve as many lives as possible while caring fairly and compassionately for those with the greatest need?
So, which is the right decision?
Maria Carpenter 19 Jun 2026 Should the healthcare system fund the preventive intervention that may protect 1000 children from serious illness?
Or should it fund the advanced treatment that could transform one patient’s life?
There is no universally correct answer.
The patient’s perspective will understandably differ from that of someone responsible for an entire population.
A fair healthcare system must try to reconcile both through evidence, transparent processes and defensible principles.
Every medical breakthrough creates new opportunities for patients and new responsibilities for those entrusted with funding healthcare.
Ensuring that funding decisions are informed by evidence, guided by fairness and directed towards achieving the greatest possible health benefit lies at the heart of every sustainable healthcare system.
