South Africa’s healthcare system is under growing strain and incremental change will no longer be enough. Rising demand, escalating costs and capacity constraints in the public sector are forcing a hard reckoning about how healthcare is delivered and funded.
According to Mark Bishop, Deputy Chairperson of the Hospital Association of South Africa (HASA), the future of healthcare will depend on how effectively the country leverages all available resources, particularly through collaboration between the public and private sectors.
With more than 30 years’ experience in private healthcare and his current role as Chief Commercial Officer at Lenmed Health Group, Bishop brings a pragmatic view shaped by both frontline realities and long-term system planning. He argues that private hospitals are already an integral part of South Africa’s healthcare ecosystem and should be recognised as such in policy and planning discussions.
Over the past four decades, private hospitals have expanded bed capacity significantly, while public sector capacity has failed to keep pace with population growth. This imbalance has left public facilities under severe pressure, with knock-on effects for patient outcomes, waiting times and staff morale. The private sector’s role in absorbing demand has therefore become critical, not optional. All industry players, providers and funders, will need to consider the best collaborative approach, and the impact this would have for all and not just concentrate on the impact on their own organisations.
Yet sustainability remains the defining challenge for the entire health system. Affordability pressures affect both public and private healthcare, driven by the same cost factors such as staffing shortages, ageing infrastructure and the high price of medical equipment and technology. Bishop believes the conversation must shift from sector-specific blame to system-wide efficiency, with a sharper focus on how limited resources are used.
The medical schemes landscape illustrates this tension clearly. While schemes are well governed, they operate in an increasingly constrained environment. Membership growth has stagnated, the population is ageing and chronic disease is on the rise. At the same time, advances in medical technology continue to improve care, but at a cost the system struggles to absorb.
Bishop is firm in his view that expanding medical scheme coverage is essential if South Africa is serious about affordability and access. Increasing the number of contributors would lower unit costs and reduce pressure on public hospitals. Proposals such as mandatory medical scheme membership for employed individuals, supported by HASA, should be debated openly and seriously as part of the broader path towards universal healthcare. This would need to be done with changes to the reimbursement processes for private care, reducing the impact of fee for service and aligning with quality improvements.
From Bishop’s perspective, one of the most underutilised solutions lies in public-private collaboration. The private sector has spare capacity that could immediately be used to treat publicly funded patients. More structured partnerships, including shared infrastructure, co-located facilities and service-level agreements, could shorten waiting lists, contain costs and improve access, without the delays associated with building new public facilities. The caution, is that this needs to align with a national strategy to increase the rate at which nurses are trained, the reality is that both public and private sectors struggle to do the limited professional nurse resources.
Reflecting on his career, Bishop notes a more informed and engaged patient population and a healthcare sector that has been reshaped by consolidation and regulation. These shifts, he argues, demand greater flexibility, clearer policy alignment and a willingness to move beyond ideological divides.
At Lenmed Health Group, Bishop’s commitment is anchored in the organisation’s long-standing focus on community-based healthcare, a principle that has guided the group since the founding of Lenmed Ahmed Kathrada Private Hospital more than 40 years ago. For him, private healthcare’s success should be measured by its contribution to broader societal wellbeing.
As South Africa’s healthcare system approaches a tipping point, Bishop is unequivocal, no single sector can solve these challenges alone. Progress will require political will, policy coherence and genuine collaboration across public and private healthcare. Without this, the gap between demand and delivery will continue to widen with consequences the country can ill afford.
