Edition June 2026

Over the past three decades, South Africa’s private healthcare financing environment has evolved significantly, reflecting the broader growth and maturity of the country’s constitutional democracy. This progress has been underpinned by a clear constitutional and legislative framework, reinforced by robust regulation through the Medical Schemes Act of 1998. 

The Act has been instrumental in strengthening protection for members, improving governance within the industry, and ensuring that access to healthcare benefits is managed in a fair, transparent, and rules-based manner.

In an interview with Public Sector Manager magazine, the Chairperson of the Council for Medical Schemes (CMS), Dr Thandi Mabeba, said the celebration of 30 years of South Africa’s constitutional democracy is a milestone comprising a celebration of progress and a reminder of the work that still lies ahead. 

“It is an important moment to pause and reflect on how far the country has come in advancing dignity, rights, and access to healthcare for all citizens. At the same time, it is important to recognise that challenges remain, especially in relation to affordability and rising healthcare costs: pressures that affect households directly and continue to shape the way the system must evolve,” she said. 

Mabeba is at the helm of South Africa’s statutory regulator of the medical schemes industry, which ensures that medical schemes operate fairly, transparently, and in a financially responsible way, while always keeping the interests of members at the centre.

Part of the council’s mandate is to ensure that members understand their rights, that schemes treat people fairly, and that complaints are investigated and resolved. 

National Health Insurance

For Mabeba, the signing of the National Health Insurance (NHI) Act of 2023 marks a significant milestone in South Africa’s health reform journey. Importantly, however, the Act does not repeal the Medical Schemes Act of 1998. Instead, it provides for a complementary coexistence and a phased transition, with most of its key provisions still subject to proclamation. As a result, implementation is expected to unfold gradually over an extended period.

“In this sense, the CMS mandate has not fallen away or been displaced. Rather, it continues to operate within a transitional and evolving healthcare financing architecture,” she explained.

Evolving role

Within this context, the CMS’s advisory function has become even more prominent. The organisation continues to provide guidance to the Minister of Health on regulatory and policy matters, now within a reform environment that is both complex and fast evolving. 

This includes a growing expectation that the CMS will contribute as a key technical institution supporting the broader design and transition of the health system.

“This includes advising on the alignment of prescribed minimum benefits with emerging NHI benefit structures, supporting reforms aimed at strengthening risk pooling, affordability, benefit standardisation and helping to clarify the demarcation between medical schemes, insurance products, and services intended for funding under the NHI framework,” she explained. 

In addition, the CMS contributes essential regulatory data, actuarial analysis, and sector intelligence that inform the purchasing and system design considerations of the NHI Fund.

These contributions, she said, are not new responsibilities created by the NHI Act, but rather a natural extension of the CMS’s accumulated regulatory expertise and its established statutory purpose under the Medical Schemes Act.

In this way, the CMS continues to occupy a unique and important position within South Africa’s health financing landscape. 

“The CMS remains a custodian of the existing regulatory framework, while also serving as a technical anchor supporting the country’s gradual transition towards a more integrated and equitable health system,” she added.

Universal health coverage      

The current journey towards implementation of the NHI forms part of the broader national effort to move closer to universal health coverage. 

While the system is still evolving, Mabeba said the intention is clear: to ensure that access to quality healthcare is not determined only by income or employment but that it is progressively expanded to all South Africans in a fair and equitable way.

“The regulatory system continues to safeguard financial stability, promote transparency, and ensure that members are treated fairly, even as the broader health system undergoes change,” she emphasised.

The future of the CMS, within the context the NHI reform, is increasingly defined by continuity and purposeful evolution. Its legal foundation continues to provide stability and certainty in a sector that remains central to the country’s health financing. 

At the same time, the CMS is consciously expanding and repositioning its role to remain 

“A key area of involvement is ongoing policy work on regulatory gaps that arise at the intersection of the current medical schemes environment and the evolving NHI framework,” she said. “This includes participation in discussions on the development of structured, multi-layered negotiation platforms aimed at improving coordination across the health system”.

The forums are intended to support more transparent and coherent engagement between stakeholders on issues such as benefits, pricing, and service delivery areas that are becoming increasingly complex in a transitioning system.

The CMS is also actively represented on a range of technical committees and working groups convened by the National Department of Health. 

“This engagement not only strengthens the quality of decision-making but also ensures that the regulatory voice is present in shaping system-wide reforms. Importantly, this expanded role is not a shift away from CMS mandate, but rather an extension of it,” she explained. 

In essence, Mabeba said the CMS is evolving into a more visible and influential institution within the health landscape- one that continues to provide regulatory stability, while also contributing meaningfully to the national dialogue on reform, integration, and the future architecture of healthcare in South Africa.

Mabeba is a seasoned governance leader, clinician, medico-legal expert and health economist who began her career in medicine. Her academic qualifications include a Bachelor of Laws, a Master’s degree in Medical Law and Ethics, a Postgraduate Diploma in Health Economics, and a Certificate in Corporate Governance.

Under her leadership, the CMS has achieved its highest governance performance score of 82%, surpassing the public sector benchmark of 74% and closely aligning with the private sector benchmark of 84%.