Health Quality Assessment’s (HQA) 2024 review of healthcare quality in South Africa’s private sector highlighted both progress and gaps in prevention, early detection and chronic disease management. The results draw on data from schemes representing about 80% of the country’s medical scheme population and cover more than 200 standardised healthcare quality indicators.
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These indicators measure how well patients are screened, monitored, and treated across the continuum of care – from preventative healthcare services to hospital-based interventions.
“Funders cannot simply pay for an intervention without knowing its value.
“Quality metrics guide investment into what works, improve efficiency and reduce the need for further healthcare by preventing avoidable illness.
“By measuring quality, medical schemes are investing in quality and outcomes, ensuring that every healthcare rand spent improves member health, reduces inefficiencies and supports value-based care,” said Louis Botha, CEO of HQA.
This year’s results introduced two new measures for public reporting – HIV viral load testing and Caesarean section rates – alongside established reported indicators such as influenza (flu) vaccination, mammography, colorectal cancer screening, and HbA1c testing for diabetes.
The results were presented at HQA’s 21st Annual Industry Results Presentation and Clinical Quality Conference, which featured panel discussions on maternal and newborn care, AI’s role in improving the quality of healthcare, the importance of data access for measuring quality, and managing patients living with HIV.
2024’s key findings
Diabetes care (HbA1c testing)
HbA1c testing measures average blood sugar levels over three months and is critical for tracking diabetes control and preventing serious complications such as kidney failure, vision loss, heart disease and stroke.
Clinical guidelines recommend at least two HbA1c tests per year for those living with diabetes.
- Since 2010, annual HbA1c test coverage has improved significantly, with some schemes nearing 90% coverage for at least one test per year.
- Rates for two-test coverage are also improving, but there remains variation across schemes, highlighting opportunities for further progress and adherence to guidelines.
HIV viral load testing
Viral load testing is a critical tool in HIV management, providing a reliable indicator of how well antiretroviral therapy (ART) is working.
Among beneficiaries consistently claiming for ART, around 85% had at least one viral load test in the past year, which is well below the global guidelines of at least 95% of PLHIV on ART having a suppressed viral load.
This represents a decline from the peak of about 95% in 2015, underlining the importance of continued focus on ensuring regular monitoring as part of comprehensive HIV care.
Caesarean section rates
The World Health Organisation recommends a C-section rate of 10–15% for medically necessary cases, yet all participating schemes in this year’s results reported rates above 70%.
These high figures mirror a broader international trend and underline the importance of ongoing discussion between healthcare providers and expectant parents about the timing and necessity of the procedure, the choice between an elective caesarean section and normal delivery and weighing the health risks and benefits for the baby.
Breast cancer screening (mammography)
Coverage has been steady at around 21–25% of eligible women having a mammogram in the past 2 years, with some schemes achieving over 40% – a testament to focused screening initiatives.
Importantly, most medical schemes include mammograms as a covered benefit, meaning eligible members can access this potentially life-saving screening without additional out-of-pocket costs.
Increasing awareness of this benefit and encouraging members to use it as part of their routine preventive care could help raise screening rates and improve outcomes for more women.
HQA also measures the proportion of female beneficiaries aged between 50 and 74 years who have not had a mammogram over five years. This measure has decreased from 87,7% in 2016 to 64,6% in 2024.
Flu vaccination (adults 65+)
Coverage among members aged 65 and older has more than doubled over the past decade – from 8% in 2010 to 21% in 2024.
Most medical schemes cover the cost of the flu vaccine, enabling eligible members to access it without additional out-of-pocket expenses.
Increasing awareness of this benefit and encouraging annual vaccination could help protect more of the most vulnerable members each flu season.
Colorectal cancer screening
While Faecal Occult Blood Test (FOBT) rates remain low, colonoscopy coverage has improved steadily, from 7% in 2014 to 12% in 2023, with some schemes achieving up to 25%.
These results show encouraging momentum in increasing uptake, particularly among schemes with targeted awareness campaigns.
Sustainable health system
International studies show that health plans engaging in regular quality measurement outperform those that do not.
The participating schemes’ commitment to measuring and improving quality is a critical step towards better outcomes and a more sustainable health system.
