Rising Costs, the Missing Middle, and Refurbished Medical Equipment as a Cost-Saving Option
South Africa is facing growing pressure on healthcare affordability as medical scheme contributions continue to rise faster than general consumer inflation.
For households already dealing with unemployment, stagnant income growth and rising essential costs, the increasing cost of private healthcare can force difficult decisions: maintain comprehensive medical aid, downgrade to a cheaper option, or accept greater exposure to out-of-pocket medical expenses.
The issue extends beyond monthly medical aid contributions. As healthcare costs rise, consumers may face higher co-payments, specialist tariff shortfalls and additional expenses for medical equipment required at home or in private practice.
Understanding what is driving these costs, and where there are practical opportunities to reduce healthcare expenditure, is becoming increasingly important.
One potential cost-saving option is refurbished medical equipment. While it is not a solution to medical inflation itself, purchasing suitable used or professionally refurbished equipment can reduce the upfront cost of certain healthcare products when the equipment is sourced responsibly and its condition, servicing and warranty are properly verified.
1. Why Is Medical Aid Becoming Less Affordable in South Africa?
South Africa's medical scheme affordability problem is being driven by several factors at the same time.
Kevin Aron, Principal Officer at Medshield Medical Scheme, has described the country's economic conditions as a major contributor to the problem. High unemployment, weak economic growth, rising essential-service costs and increasing healthcare demand all place pressure on consumers and medical schemes.
At the same time, medical schemes must remain financially sustainable while covering the healthcare needs of their members.
This creates a difficult cycle:
Economic pressure → reduced affordability → members move to cheaper cover or leave schemes → greater pressure on remaining risk pools → rising healthcare expenditure → higher contributions → further affordability pressure.
The Medical Scheme Affordability Cycle
| Economic pressure, unemployment & weak income growth |
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| Consumers struggle to afford comprehensive medical scheme cover |
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| Members move to cheaper options or delay joining medical schemes |
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| Medical schemes face increasing pressure from healthcare utilisation |
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| Contributions need to rise to maintain financial sustainability |
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Affordability pressure increases
This does not mean every medical scheme or member experiences the same financial pressures. However, it illustrates why affordability is becoming a central issue within South Africa's private healthcare system.
Medical Aid Increases Versus Consumer Inflation
The gap between general inflation and medical scheme contribution increases has become particularly noticeable.
For 2026, the Council for Medical Schemes (CMS) recommended that medical scheme contribution increases and cost assumptions be limited to 3.3% plus reasonable utilisation estimates. Actual increases across schemes were considerably higher.
The source material highlights increases including approximately 6.8% for Bestmed, 7.2% for Discovery, 9.9% for Momentum and 19.15% for Sizwe Hosmed.
These increases can be difficult for households to absorb when wages and household income are not increasing at the same rate.
Kevin Aron has argued that keeping medical scheme contribution increases in line with CPI is difficult because medical costs have historically increased faster than general inflation.
The "Missing Middle"
One of the biggest challenges is faced by people who rely on private healthcare but cannot comfortably afford comprehensive medical scheme cover.
Aron describes this group as the "missing middle": working South Africans whose income and circumstances leave them reliant on private healthcare but who may struggle to afford higher levels of medical cover.
According to Aron, around R3,000 per month can represent an affordability ceiling for many consumers, with more expensive options becoming increasingly difficult to afford.
The result is that some members may choose lower-cost options even when their healthcare requirements would ideally call for more comprehensive cover.
This creates another problem: reducing the monthly premium can reduce immediate financial pressure, but it may increase exposure to healthcare costs later.
2. The Hidden Cost of Downgrading Medical Aid
When medical aid becomes unaffordable, downgrading cover can seem like the obvious solution.
However, a cheaper plan can mean fewer benefits, higher co-payments or greater exposure to costs that are not fully covered by the scheme.
Specialist Tariff Shortfalls
One of the major sources of unexpected medical expenses is the difference between what a healthcare provider charges and what a medical scheme reimburses.
Private specialists can charge substantially more than a medical scheme's applicable tariff. When this happens, the member may be responsible for paying the difference.
These shortfalls can become particularly significant during hospitalisation or complex medical procedures.
According to the Council for Medical Schemes' 2024 Industry Report, total out-of-pocket payments reached R46.3 billion in 2024, highlighting the continued financial burden placed on medical scheme members.
For individuals and families, even a single unexpected shortfall can place considerable pressure on savings.
Gap Cover Can Reduce Some of This Exposure
Gap cover is designed to help protect members against certain shortfalls between medical scheme rates and healthcare provider charges.
It is important to understand, however, that gap cover is not a replacement for medical aid and does not necessarily cover every healthcare expense. Members should understand the terms, limits and exclusions of their specific policy.
The broader point is that reducing the cost of medical aid does not necessarily reduce the total cost of healthcare.
It can simply shift more of that cost from an insured expense to an out-of-pocket expense.
3. The Retirement Impact of Rising Healthcare Costs
Healthcare affordability becomes even more important when viewed over a long retirement.
Medical aid is often treated as another monthly household expense, but healthcare requirements can change substantially over a person's lifetime.
If medical scheme contributions and healthcare expenses rise faster than general inflation, retirement planning based solely on standard CPI assumptions may underestimate future healthcare costs.
This creates a potential mismatch:
| Healthcare expenses | Retirement planning |
|---|---|
| Medical scheme contributions can rise faster than CPI | Retirement income is often planned using general inflation assumptions |
| Healthcare needs may increase with age | Medical expenses may become a larger proportion of household expenditure |
| Downgrading cover can reduce premiums | Lower cover can increase exposure to co-payments and shortfalls |
Healthcare should therefore be considered as part of long-term retirement planning rather than simply another monthly bill.
This does not necessarily mean investing specifically in healthcare assets or taking additional investment risk. Rather, it means recognising healthcare costs as a significant future expense and ensuring that retirement planning accounts for them appropriately.
4. Where Can Healthcare Costs Be Reduced?
Not every healthcare expense can be avoided.
Medical scheme contributions, specialist fees and medical treatment are largely determined by factors outside an individual's direct control.
However, certain healthcare-related expenses, particularly equipment and hardware, can provide more flexibility.
This is where refurbished medical equipment can become relevant.
For patients, families, medical practices and healthcare facilities, buying used or professionally refurbished equipment can reduce the initial cost of acquiring necessary healthcare hardware.
It is not appropriate for every type of medical equipment, and cheaper does not automatically mean safer or better.
The key is buying the right equipment from the right source and understanding what has been done to it before purchase.
5. Refurbished Medical Equipment as a Cost-Saving Alternative
Refurbished medical equipment has become an increasingly relevant option for healthcare organisations and professionals looking to manage capital expenditure.
Healthcare and pharmaceutical executive André Meyer has highlighted several advantages of refurbished equipment, particularly its ability to reduce the purchase price compared with new equipment.
The basic principle is straightforward: medical equipment can depreciate significantly after its initial purchase, meaning buyers may be able to acquire capable equipment at substantially lower prices on the secondary market.
For Consumers and Home-Care Patients
Refurbished or used equipment can be relevant for people who need equipment at home for recovery, mobility or long-term care.
Examples include:
- Wheelchairs
- Walkers and mobility aids
- Manual hospital beds
- Certain home-care equipment
- CPAP machines
- Oxygen concentrators
For lower-cost, non-invasive equipment, buying used can potentially reduce the financial burden placed directly on the patient or family.
However, condition and safety still matter. Equipment should be inspected for structural damage, excessive wear and missing or degraded components.
For Healthcare Providers and Private Practices
The opportunity is potentially even greater for healthcare businesses.
Medical practices, clinics and healthcare professionals can face significant capital expenditure when purchasing equipment required to establish or expand a practice.
Depending on the equipment, refurbished options can provide access to more advanced models at a lower upfront cost than purchasing new.
Examples can include:
- Examination couches
- Ultrasound equipment
- Patient monitors
- Diagnostic equipment
- Theatre equipment
- Other specialised medical hardware
For a smaller practice, the difference between buying new and refurbished equipment can potentially free up capital for other business requirements.
6. The Pros and Cons of Refurbished Medical Equipment
Buying refurbished equipment is not simply about finding the cheapest available option.
The condition of the equipment, level of refurbishment, availability of spare parts, technical support and warranty can all affect the true value of the purchase.
Advantages
Lower upfront cost
Refurbished equipment can cost substantially less than comparable new equipment, depending on its age, condition and refurbishment level.
Access to higher-tier equipment
A lower purchase price can potentially allow smaller practices and healthcare providers to access equipment that would otherwise be outside their budget.
Different refurbishment levels
Some suppliers offer different levels of refurbishment. Certified pre-owned equipment may undergo extensive inspection, testing, component replacement and cosmetic restoration, while other equipment may receive more limited mechanical refurbishment.
This gives buyers the ability to balance price against condition and support.
Potential Disadvantages
Shorter remaining lifespan
Used equipment has already been operated and may need to be replaced sooner than a new equivalent. The expected remaining lifespan should therefore form part of the purchasing decision.
Warranty and support limitations
Lower-cost used equipment may not come with the same warranty, technical support, spare parts availability or maintenance programmes available with new equipment.
Calibration and safety
For diagnostic, monitoring or other higher-risk equipment, poor maintenance or inadequate calibration can create serious problems.
The cheapest piece of equipment is not necessarily the cheapest option over its full useful life.
7. Choosing the Right Refurbished Medical Equipment
Not every category of medical equipment carries the same level of risk.
A sensible approach is to consider the equipment's intended use, clinical risk, complexity and the level of technical support required.
| Equipment category | Relative risk | What to consider |
|---|---|---|
| Mobility and manual-care equipment | Lower | Check structural integrity, brakes, wheels, joints and general condition |
| Powered and assistive equipment | Moderate | Verify servicing, electrical safety, sanitation and component condition |
| Diagnostic and critical-care equipment | Higher | Look for professional refurbishment, documented servicing, calibration and warranty support |
Lower-Risk Equipment
Mechanical and non-invasive products such as wheelchairs, walkers and manual-care equipment are generally simpler to assess.
Buyers should still check for structural fatigue, damaged components, worn brakes, missing parts and general deterioration.
Moderate-Risk Equipment
Powered equipment and home-care devices require greater care.
Examples include CPAP machines, oxygen concentrators and electric beds.
Where possible, buyers should establish:
- Whether the equipment has been professionally serviced
- Whether it has been properly sanitised
- Whether consumable components have been replaced where necessary
- Whether electrical and mechanical functions have been tested
- Whether the supplier provides a warranty
Higher-Risk Equipment
Diagnostic and critical-care equipment requires substantially greater scrutiny.
This can include equipment such as ultrasound systems, patient monitors and defibrillators.
For these products, buyers should look for documented servicing, calibration records, appropriate technical support and a clear warranty or guarantee.
For higher-risk equipment, buying from a reputable medical equipment supplier is preferable to purchasing from an unknown private seller.
8. Can Medical Aid Pay for Refurbished Medical Equipment?
This is an important question for anyone considering refurbished equipment.
The answer is: potentially, but it depends on the medical scheme, benefit option, equipment and supplier requirements.
There is no universal rule that every medical scheme will reimburse every used or refurbished medical device.
Before making a purchase, members should establish exactly what their scheme covers and what conditions apply.
Factors That May Affect Reimbursement
1. Your scheme and benefit option
Coverage for durable medical equipment can vary between schemes and benefit options.
Depending on the specific plan, equipment may potentially be funded through a Medical Savings Account, day-to-day benefits, a specific equipment benefit or another applicable benefit structure.
Members should confirm the applicable benefit before purchasing.
2. Supplier requirements
Some medical schemes may require equipment to be purchased through an approved, registered or accredited supplier.
This is particularly important when buying refurbished equipment, as an informal peer-to-peer transaction may not meet the scheme's reimbursement requirements.
3. Prescription or clinical motivation
Certain equipment may require a prescription, clinical motivation or other supporting documentation.
The exact requirements depend on the scheme, equipment and benefit.
4. Pre-authorisation
Higher-value equipment may require pre-authorisation before the purchase is made.
Members should not assume that buying the equipment first and submitting the invoice afterwards will guarantee reimbursement.
What to Do Before Buying
Get a detailed quotation.
Ask the supplier for an itemised quote identifying the equipment, model, price and relevant supplier details.
Check with your medical scheme first.
Confirm whether the specific item is covered under your benefit option, whether refurbished equipment is eligible, what benefit will fund it and whether pre-authorisation is required.
Confirm supplier requirements.
Ask the scheme whether the supplier needs to be registered, accredited or approved for the purchase to qualify.
Check the equipment's condition and history.
Ask whether the equipment has been serviced, refurbished, calibrated or tested and whether relevant documentation can be provided.
Check the warranty.
A written warranty can provide important protection if equipment develops a fault shortly after purchase.
Ask about technical support.
For more complex equipment, establish whether spare parts, maintenance, repairs and technical assistance are available.
9. Buying Used Medical Equipment: A Practical Checklist
Whether you are a private individual, healthcare professional, clinic or medical facility, consider the following before buying.
Before Purchase
- Identify exactly what equipment you need.
- Compare the refurbished price against the cost of buying new.
- Check the age and expected remaining lifespan.
- Establish the equipment's service and maintenance history.
- Confirm whether the equipment has been professionally refurbished.
- Ask whether calibration or safety testing has been performed where applicable.
- Confirm whether replacement parts are available.
- Check whether the supplier offers a warranty.
- Confirm whether technical support is available.
- If you intend to claim from medical aid, confirm eligibility before purchasing.
Read: Is it Safe to Buy Second-hand Medical Equipment?
Avoid Making Price the Only Consideration
A refurbished device that costs less initially may not provide good value if it requires expensive repairs, has no available spare parts or needs to be replaced shortly afterwards.
The better question is not:
“What is the cheapest medical equipment I can buy?”
It is:
“What is the safest and most appropriate equipment I can acquire at the lowest realistic total cost?”
10. A More Sustainable Approach to Healthcare Costs
South Africa's medical-aid affordability problem cannot be solved simply by buying refurbished equipment.
Contribution increases, healthcare utilisation, specialist fees, chronic disease and broader economic conditions are structural issues that require broader solutions.
However, individuals and healthcare providers can still look for areas where expenditure can be managed more effectively.
That can include choosing appropriate medical scheme cover, understanding gap-cover protection, planning for healthcare costs during retirement and, where appropriate, considering refurbished equipment instead of automatically buying new.
For consumers, the potential benefit is lower upfront spending on suitable home-care equipment.
For healthcare providers, refurbished equipment can potentially reduce capital expenditure while providing access to capable equipment at a lower acquisition cost.
The key is to balance price, condition, clinical risk, refurbishment quality, warranty and ongoing support.
As healthcare costs continue to put pressure on South African households and healthcare businesses, being able to compare new, used and refurbished equipment options gives buyers another way to manage expenditure without automatically compromising on the equipment they need.
Before purchasing, however, buyers should always verify the condition and suitability of the equipment and, where medical aid reimbursement is intended, confirm the requirements of their specific medical scheme and benefit option in advance.