With flexibility comes complexity - That is where digital user experience matters. Younger members, in particular, gravitate to app-first administration, topping up day-to-day funds instantly for a dependent’s dental procedure, for example, without call centre friction. Done well, this reduces stress at the point of care and turns cover design into a dynamic tool rather than a once-a-year gamble.

Policy context inevitably looms, and Yatt is explicit. He supports the principle of universal access to quality healthcare as a measure of a country’s sophistication. But he is sharply critical of the National Health Insurance model as currently framed, both for its likely practical effects and for the way it is being advanced. In his view, sweeping the entire population into a single state-run funding and purchasing system will inevitably mean rationing by waiting lists and reduced choice, an experience already familiar in other national systems.

Today, even without medical aid, many serious conditions in urban centres (such as heart attacks and certain cancers) can access high-quality public tertiary care; where the state system struggles is in everyday medicine and basic infrastructure. Over-centralising funding while crowding out well-run, member-governed, not-for-profit schemes risks adding demand to a system whose main problems are management, maintenance and accountability.

Yatt argues there is a more constructive route to universalism that leverages, rather than sidelines, the private risk pool. Several levers stand out. First, broaden participation in schemes by introducing income-linked mandatory membership above a reasonable earnings threshold, so the healthier and younger expand the pool and bring average costs down.  

Second, permit more flexible benefit design instead of prescribing an ever-expanding list of must-pay items at any cost, which can drive over-servicing and defensive medicine.  

Third, implement long-standing Health Market Inquiry recommendations aimed at price transparency, clinical coding standards and procurement efficiency. In that scenario, those who can and wish to self-fund through schemes do so, freeing scarce public resources for the most vulnerable, while the state focuses on governance and quality in facilities, rather than owning every funding decision.

His critique is not a defence of the status quo. Yatt is clear that schemes must keep proving their social value: they are not-for-profit entities run by trustees on behalf of members, not profit-maximising insurers. When industry bodies such as the Health Funders Association and the Board of Healthcare Funders oppose parts of the NHI legislation, they do so, he says, because the model on the table is likely to harm members, by reducing choice, degrading service levels and raising system-wide risk, rather than because schemes are “protecting vested interests”. In his framing, the real “vested interest” is the member’s health and financial stability.

Data underscores the case for prevention - Fedhealth’s analysis shows that members who fail to adhere to chronic medication, such as antihypertensives, cost the scheme materially more over time than adherent members. That is not a moral judgment; it is a measurable risk signal. Proactive programmes, reminders, outreach, integrated benefits, are therefore both compassionate and financially sound.

The through-line is simple. If medical schemes are to remain viable for the many rather than the few, they must deliver three things at once: uncompromising cover for the big, insurable events; real-time flexibility for everyday care without waste; and relentless focus on prevention powered by data and design. Fedhealth’s Sanlam partnership frames that as a single continuum of wellbeing and wealth.  

In a system under strain, it is a practical blueprint: keep the mutuality, modernise the mechanics, and make the app do the heavy lifting, while insisting that reform builds on what already works.