Elder Care and Private Health Insurance in South Africa: The Pathos of Race-Class

ABSTRACT

This article shows how age as a category of dependency upends popular consciousness about race and class within postcolonial health systems. White individuals working within South Africa’s private health insurance (medical aid) market and allied fields face a conundrum with respect to elder care. Some policies accommodate older adults’ needs, but being older is costly and long-term residential care is excluded. Critically, these workers’ position as middle- and upper-class enables them to pity older, poorer whites and blacks who more often use a dysfunctional public health sector, yet the elder care gap and other limitations reveal that these workers’ own class position is also tenuous.

KEYWORDS:

• South Africa
• class
• dependency
• health insurance
• older adults
• race

Acknowledgments

My thanks go first to my respondents for taking time from work to carefully explain their businesses to me. During fieldwork in 2014–2015, I was aided by Shabir Moosa, Stephen Pentz, Shehnaz Munshi, Alex van den Heever, Mphile Makama, Mzwandile Lukhele, and Dumsile Jiyane. In 2016–2017, Tyler Anderson, Teri Del Rosso, and Jason Danely provided helpful insights in writing-up. Clifton Crais, Pamela Scully, Melissa Hackman, Kristin Mann, Kristin Phillips, Jennie Burnett, Brian Goldstone, Subha Xavier, Miriam Kilimo, Madelyn Stone, Rachel Shapiro, and Ashley Parcells read and commented on the first draft of this article at a 2017 invited seminar at Emory University’s Institute of African Studies. Finally, I thank three anonymized reviewers, Lenore Manderson and Victoria Team for their editorial guidance.

Notes

^1. Some restricted schemes level premiums based on members’ placement in two-three different “income bands” proportionate to their annual earnings.

^2. In 2008 at least, the Council for Medical Schemes found that pensioner costs were minor in total scheme spending (Ruiters and Van Niekerk 2012:154).

^3. These respondents are also arguably representative of broader discourses on health insurance amid NHI. My claim derives from a content analysis of 60 South African newspaper articles on NHI (July 2014–August 2015) conducted by my research assistant Tyler Anderson. This analysis showed recurrent themes of skepticism for the ANC’s NHI project altogether and private providers and wealthier citizens’ resignation in financially supporting policy changes as the main contributing tax base.

^4. A late joiner is defined by the Medical Schemes Act as “an applicant or the adult dependant of an applicant who, at the date of application… is 35 years of age or older, but excludes any beneficiary who enjoyed coverage with one or more medical schemes as from a date preceding 1st April 2001, without a break in coverage exceeding three consecutive months since 1st April 2001” [sic].

Additional information

Funding

This study was funded by a Wenner Gren Foundation for Anthropological Research Post PhD Research Grant and the University Research Council at the University of the Witwatersrand.

Notes on contributors

Casey Golomski

Casey Golomski is a cultural and medical anthropologist working in Southern Africa. His research on insurance and health has appeared in Social Dynamics, American Ethnologist, and Culture, Health & Sexuality.