National Health Insurance
Income and Medical Scheme Membership
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In the years from 2005 to 2007 the General Household Survey data severely under-counted the numbers on medical schemes. However GHS2008 has an identical estimate to that produced using figures from the Council for Medical Schemes and the ASSA2003 population in the IMSA NHI Policy Brief 2. In 2008, 15.9% of the population were on medical schemes.
The graph below uses the same broad categories of income and social security as before, but now compares those in medical schemes with those without health insurance. The figures are also shown in the table that follows.
 Figure 4: Income and Social Security by Medical Scheme Coverage, proportion by age-gender band
Of interest in the graph above is that there are people earning below the tax threshold who are members of medical schemes. They may either be receiving a significant subsidy from the employer to be on a scheme or may be the lower earning spouse of a member.
There are a surprising number of people on social security who are on medical schemes in the GHS2008 data. This alters our perception and bears further examination. The may have had full medical scheme coverage in retirement from previous employment or marriage, for example. In earlier GHS studies, like GHS2005, there had been confusion between the social security grant for old age and private old-age pensions.
Table 1: Income and Social Security Status by Medical Scheme Coverage 
Only 59.5% of people earning above the tax threshold are on medical schemes in the voluntary environment. Note the small but significant numbers reporting that they have health insurance but not earning above the tax threshold. They may either be in receipt of a substantial employer subsidy to join a medical scheme, be a pensioner with heavily subsidised cover or be the spouse of a higher income earner. Included in those with “no earnings” are non-working spouses and children.
The graph below shows the very strong pattern of medical scheme coverage by income level. This pattern has been observed for many years but this is drawn using the most recent data available, from the GHS2008. This graph epitomises the problem of affordability of medical schemes
 Figure 5: Proportion of Medical Scheme Coverage by Income Band
For those earning in the highest income groups, medical scheme coverage is about 80% but this declines rapidly to under 40% in the band just above the tax threshold. The group who refuse to give income has relatively high medical scheme coverage, giving credence to the assumption that they may generally be earning above the tax threshold.
While the average coverage is 59.5% for all groups earning above the tax threshold, when turned into the number of people the lower income groups are more significant, as shown overleaf. It is estimated from the GHS2008 that there are 1.772 million people who are earning above the tax threshold and are not covered on medical schemes. This calculation excludes family members.
The GHS2008 figures are in the same “ball-park” as the Council for Medical Schemes (CMS) data on the number of members. The CMS has 3.307 million average membership (principal members) in 2008 compared to 3.566 million who are earning any income and on a medical scheme in the GHS2008 data. The latter includes dual-income households so there is some double counting.
 Figure 6: Medical Scheme Coverage by Income Band
The graph above indicates the potential number of income earners in each band that are not currently on medical schemes. Estimates of how many people might be covered if coverage is expanded in various ways are dealt with in section 5.
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