From Fee-For-Service to Outcomes: Reimagining the Future of South African Healthcare

At a recent preventive medicine conference, a rare but inspirational consensus emerged across stakeholders from government, private healthcare, pharmaceuticals, non-profits, and administrators: the current fee-for-service (FFS) model is no longer fit for purpose and sustainable. While it has historically enabled access and activity, it has also entrenched fragmentation, incentivised volume over value, and diluted accountability for patient outcomes. The future of South African healthcare will not be defined by how much care is delivered, but by how well it improves lives.

Imagine a patient with diabetes navigating a seamlessly coordinated system – her medication adherence tracked in real time, her glucose levels monitored proactively, and her care team aligned around a shared, longitudinal record. Interventions occur before complications arise, not after. This is not aspirational – it is entirely achievable. It represents a decisive shift from reactive, episodic care to integrated, preventive, and outcomes-driven healthcare.

South Africa stands at a critical inflection point. Our healthcare system remains largely oriented toward treating illness rather than sustaining health. Structural fragmentation, data silos, and legacy reimbursement models have created an environment where more interventions do not necessarily translate into better outcomes. Value-based care (VBC) offers a fundamentally different paradigm, one that aligns financial incentives with measurable health outcomes, supported by interoperable data systems, multidisciplinary collaboration, and standardised clinical pathways.

At Sanlam and AfroCentric, this shift is being operationalised through the integration of financial and health solutions into a unified “Wealth and Health” proposition. This model moves beyond traditional managed care by embedding healthcare within broader financial resilience strategies, recognising that health outcomes and financial wellbeing are inextricably linked. It is a deliberate repositioning: from payer to partner, from administrator to orchestrator of value.

Central to value-based care is the reconfiguration of incentives. Payment models must evolve to hold providers accountable not only for cost, but for quality and outcomes. This requires robust measurement frameworks, including the systematic use of Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs), ensuring that success is defined not only clinically, but through the lived experiences of patients. Transparency, comparability, and continuous improvement become the new currency of healthcare delivery.

Digital infrastructure is the backbone of this transformation. A connected, secure, and interoperable data ecosystem is essential to enable continuity of care, real-time decision-making, and system-wide accountability. South Africa’s Digital Health Strategy provides a strong foundation, but execution will determine its impact. The ability for data to move seamlessly across providers, programmes, and sectors will ultimately define the success of value-based care.

At the same time, the role of innovation – particularly artificial intelligence – is accelerating. From predictive analytics that identify high-risk patients, to automation that alleviates administrative burden allowing laser-like focus on patient well-being, technology is reshaping how care is delivered and experienced. Across the continent, innovations such as drone-based medical supply chains and mobile-first patient engagement platforms are demonstrating what is possible when necessity meets ingenuity.

However, no healthcare transformation is complete without addressing the social determinants of health. In a country marked by profound inequality, clinical interventions alone are insufficient. Access to stable housing, nutrition, employment, and social support fundamentally shapes health outcomes. For healthcare funders and providers, this means moving upstream – redesigning benefits, partnerships, and interventions that mitigate social risk and enable sustainable health improvements.

The introduction of National Health Insurance (NHI) further reinforces the need for alignment between public and private sectors. Success will depend on pragmatic collaboration, infrastructure investment, and the strategic deployment of private sector capabilities to strengthen public health delivery. Initiatives such as the CCMDD programme demonstrate that scalable, high-impact partnerships are not only possible, but essential.

The path forward is clear. We must scale outcome-based contracting, deepen clinical innovation, and embed measurement at the core of care delivery. We must invest in digital systems that connect patients, providers, and funders into a cohesive ecosystem. And critically, we must redefine value not as the cost of care, but as the outcomes achieved per rand spent.

South Africa has the opportunity to lead, not by incremental reform, but by systemic reinvention. Achieving this transformation will require a deliberate alignment with legal and regulatory frameworks – ensuring that policy, reimbursement models, and data governance evolve in step with innovation to enable, rather than constrain, value-based care.

Ultimately, the shift to value-based care is about redefining success, not in expanding lifespan alone, but in maximising health span, ensuring that added years are lived with equality, functionality, productively and with dignity. The future of healthcare will not be built on how much we do, but on how meaningfully we change lives.

CLICK HERE to submit your press release to MyPR.co.za.

Author: Ayesha Kriel from AfroCentric Group on behalf of Medscheme.

Read More at MyPR.co.za

BBC News Africa: This is the BBC’s news service for Africa.