You can't buy your way out of a broken health system

Private health system is not a parallel universe

- Dr Gustaaf Wolvaardt

(Getty Images)

Many South Africans live carefully curated lives. Private schools. Medical aid. Gated estates. Armed response. If the public system fails, the thinking goes, we simply step around it.

It is an understandable instinct. When public services feel unreliable, those who can afford to do so build private alternatives. Over time, this begins to feel like independence - proof that you have “made it”, that you are no longer exposed to the risks everyone else must endure. But health does not work that way. Unlike schooling or security, healthcare is not something you can fully opt out of. It is a complex system - dependent on people, infrastructure, regulation, training pipelines and emergency response capacity when natural disasters and pandemics strike - most of which sit firmly in the public domain, whether we acknowledge it or not.

The uncomfortable truth is this: South Africa's private healthcare system is not a parallel universe. It is a dependent subsystem, built on public foundations that are showing serious cracks. Consider the people who keep the system running. Doctors, nurses, paramedics, psychologists and pharmacists. Almost all are trained in public institutions. Many begin their careers in public hospitals. Even those working exclusively in private practice rely on public systems for specialist training, accreditation, emergency overflow and disease surveillance. When those pipelines weaken, the effects are delayed, but inevitable.