IRR Free Facts: South Africans don’t want free healthcare – they want good healthcare and the freedom to choose it

The Institute of Race Relations (IRR) today released its latest Free Facts publication, presenting 2025 polling data that illuminates South Africans’ attitudes toward public and private healthcare systems. The findings carry implications for ongoing debates around NHI and the future of healthcare delivery in South Africa.

The survey asked South Africans where they most often sought medical care. A substantial 71% reported turning to a government clinic or hospital, while 23% used a private doctor, clinic or hospital. Among those who used government facilities, the primary reason cited was affordability (26%), followed by accessibility (22%). Notably, 17% of government healthcare users said they chose it because of high-quality care.

However, the data reveal a striking gap between current behaviours and underlying preference. When asked whether they would prefer private healthcare if access barriers were removed, 56% of respondents said yes. When the question focused on affordability, asking whether they would switch if private care were made affordable, the figure rose to 59%. In both scenarios, those saying “no” represented only around one in five respondents.

Anlu Keeve, Economic Policy Analyst at the IRR, notes: “Despite 7 in 10 using government healthcare facilities today, a clear majority would switch to private care if cost and access barriers were removed. This points to an unmet demand for choice rather than preference for public healthcare.”

“These findings,” Keeve adds, “should prompt policymakers to reconsider approaches that consolidate healthcare under a single public system. The data suggests that South Africans currently using government facilities are doing so largely out of financial and geographic necessity and not by choice.”

The IRR’s Free Facts series provides accessible and data-driven insights into important policy questions facing South Africa. The full Free Facts publication released today is available here.

Media contact: Anlu Keeve IRR Economic Policy Analyst and Research Coordinator Tel: 071 929 9516 Email: anlu@irr.org.za

Media enquiries: Michael Morris Tel: 066 302 1968 Email: michael@irr.org.za