South Africa’s regulatory framework for medical schemes is out of step with today’s healthcare technology, industry figures warned at the FIA Advice Summit 2026, raising questions about whether current law will permit wider use of telehealth and artificial intelligence in coming years.
Law lags behind technology
Damian McHugh, chief marketing officer at Momentum Health, said the legal environment has not kept pace with innovations that are transforming how care is delivered and how risk is assessed. He told the panel that the principal statute governing medical schemes was drafted decades ago.
"We have a Medical Schemes Act that was written in 1998,"
McHugh said the gap between legislation and technological capability is significant and risky: the law must be able to accommodate developments expected over the next three to five years, he argued.
Telehealth as a test case
The panellist used telehealth to illustrate how regulation shapes service delivery. Before the COVID-19 pandemic, McHugh said, it had been illegal to give medical advice over the telephone. The emergency response changed that, enabling clinicians to consult remotely rather than requiring patients to travel to a consulting room.
- Remote consultations can be cheaper than in-person visits.
- Telehealth reduces transport barriers for patients and helps those needing care outside normal hours.
- Not all conditions are suitable for remote assessment; however, the model expands access where appropriate.
That change demonstrates the practical benefits of adapting regulation to support new modes of care, McHugh said, while also highlighting the need for a legal framework that anticipates technological change rather than merely reacting to it.
AI’s potential and the policy challenge
Medical schemes and healthcare providers generate and process very large quantities of information. McHugh noted that within those transaction records are patterns that could improve risk identification, forecasting and decision-making.
"AI has an unbelievable capability in dealing with large volumes of data and predicting patterns," he said, pointing to the technology’s potential to transform both clinical delivery and administrative functions.
| Issue | Regulatory implication |
|---|---|
| Telehealth expansion | Requires clarity on where remote advice is permitted and how quality is measured |
| AI-driven underwriting and care | Needs rules on data use, model transparency and consumer protection |
McHugh emphasised that AI’s best contribution may lie in improving how care is delivered rather than only streamlining back-office tasks. But realising that benefit, he said, depends on legislative and regulatory settings that allow innovation while protecting patients and scheme members.
What a refresh must consider
While the discussion at the summit focused on gaps, it also pointed to concrete areas where reform would matter. These include:
- Clarifying the legal status of remote consultations and teletriage;
- Establishing rules for use of personal health data in AI systems, including consent and governance;
- Setting standards for algorithmic transparency and fairness in underwriting and clinical decision support.
Any legislative update will need to balance innovation with patient safety, data protection and equity of access. The conversation at the FIA Advice Summit underlined that industry stakeholders are thinking about both the opportunities and the risks.
As South Africa’s healthcare sector accumulates more digital records and adopts tools that can analyse them at scale, the question is whether the legal framework crafted in 1998 can be adapted fast enough to enable beneficial change — or whether a formal refresh is required to secure public trust and broaden coverage.
