In 2025, the South African healthcare landscape continues to evolve, shaped by the findings and recommendations of the Competition Commission’s 2019 Health Market Inquiry (HMI).
The Health Market Inquiry (HMI) chaired by former Chief Justice Sandile Ngcobo was a comprehensive investigation into South Africa's private healthcare sector and aimed to understand why healthcare costs are so high, why competition in the market is limited and aimed to address these issues to ensure improved access to healthcare for all South Africans but more particularly access to private healthcare.
The inquiry examined the structure of the private healthcare market to understand how key players interact and compete. It also investigated why medical services and products are so expensive and whether these costs are justified. Additionally, the inquiry commented on the measures of quality of healthcare services and examined factors which undermine access to healthcare. Finally, it reviewed the current regulatory framework to determine if it supports or hinders competition and made various recommendations in this regard.
The HMI made a series of key findings and identified several factors that hindered competition in the private healthcare sector, some of which are briefly put as follows:
1. Unregulated supply side: The supply side of the market is largely unregulated, with negative consequences for competition and the consumer.
2. Lack of transparency in pricing: Patients and consumers faced challenges due to unclear pricing structures, making it difficult to compare costs and make informed decisions.
3. Competition concerns and anticompetitive practices: Exclusive contracts and other anticompetitive practices created barriers to entry for new players, stifling innovation and competition and ultimately access to healthcare services in the private sector.
To address some of these issues the HMI recommended implementing stricter regulations to enhance transparency and efficiency in the health market. It also called for clearer, more accessible pricing structures to help patients make informed decisions and urged measures to promote fair competition, lower costs, and attract new players to the industry.
The South African government has taken significant steps to implement the HMI's recommendations. The National Health Insurance Act 20 of 2023 (NHI) is positioned as a key vehicle to achieve universal access to quality healthcare services. In further response to the HMI, the Minister of Trade, Industry and Competition has recently published for public comment The Draft Interim Block Exemption for Tariffs Determination in the Healthcare Sector, 2025.
Section 27 of the Constitution states that everyone has the right to access health care services and mandates the state to take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of this right. The implementation of the HMI’s recommendations aligns with the Constitution as addressing the costs and availability of healthcare services will not only enhance access to healthcare but will promote equity and fairness in the provision of healthcare services and accountability and adherence to constitutional mandates.
In addition to the HMI's recommendations and the government’s efforts to implement these recommendations, funding opportunities such as the President's Emergency Plan for AIDS Relief (PEPFAR) and other international health initiatives play a crucial role in supporting South Africa's healthcare system. Despite recent funding challenges, including the termination of some USAID support, the South African government has indicated it would assist with some of the shortfalls. These efforts will be vital in complementing the HMI's recommendations and ensuring that the right to access healthcare is upheld for all South Africans.
In conclusion, the findings and recommendations of the Health Market Inquiry are pivotal in shaping a more equitable and competitive healthcare landscape in South Africa. By addressing key issues such as regulation, transparency, and competition, and through the government's proactive implementation efforts, the HMI's recommendations aim to ensure that all South Africans can exercise their right to access quality healthcare.
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