A decade of data from one of South Africa’s largest medical schemes reveals a steady and significant decline in mortality, with overall death rates falling 5.6 percent across all age groups. The findings, drawn from millions of member records, point to a healthcare system increasingly shaped by earlier detection, better treatment pathways and a stronger emphasis on prevention.
The improvement was most pronounced among younger adults. Members aged 24 to 39 saw mortality drop by more than 16 percent, while those aged 75 and older experienced a decline of nearly 8 percent. The report attributes these gains to a deliberate shift in how care is delivered. Rather than waiting for illness to progress, clinicians and health programs are identifying risk earlier and guiding patients toward sustained healthy behaviors. This approach, described as a “Prevention Dividend,” is credited with slowing disease progression and extending healthy life expectancy. Cancer outcomes have improved markedly, with mortality falling 48 percent over the decade and life expectancy for members living with cancer increasing by 7.1 years.
Despite the overall progress, the data also highlights the heavy burden concentrated among a small group of patients. In 2025, just 1 percent of members, roughly 29,000 individuals, accounted for 33 percent of total healthcare spending, nearly R25 billion. The top 5 percent of members drove 63 percent of spending, or R47 billion. These costs are largely tied to serious conditions such as cardiovascular disease and cancer, which remain the most common drivers of high-cost claims. The report emphasizes that such events are often unpredictable and can strike at any age, underscoring the importance of medical scheme coverage as a financial safety net.
Mental Health Emerges as a Major Shift in Demand
One of the most striking trends is the rise in mental health conditions, particularly among younger members. Prevalence among those aged 18 to 30 has surged by 80 percent over the past decade, with 1 in 7 young adults now receiving care for a mental health condition. The increase reflects a positive shift toward earlier engagement, as more individuals seek help before their condition escalates. However, when mental health conditions overlap with other chronic diseases such as diabetes or heart disease, the impact is substantial. Hospital admission rates and costs can be up to 3.5 times higher for members managing both a mental health condition and another chronic illness.
Looking ahead, the report signals that cardiovascular health will remain a central focus, both as a major driver of cost and as one of the most modifiable areas in medicine. The combination of deeper clinical data, behavioral science and personalized technology is expected to sharpen prevention efforts further. As more conditions are caught early and managed over longer periods, the healthcare system is shifting from episodic treatment toward sustained, integrated care. The goal is to maintain the current trajectory of improved outcomes while ensuring that access and quality remain sustainable for the long term.