From friendly society to compulsory medical aid association: The history of medical aid provision in South Africa's public sector, 1905-1907

The compulsory medical benefit scheme for white public servants in South Africa grew out of a friendly society founded in 1905. This development diverged from the experience of other members of the British Commonwealth, where universal health insurance schemes developed following the British example. The Civil Servants' Medical Benefit Association (CSMBA) addressed the needs of white public servants, leaving the non-white communities without any form of government-sponsored medical support, apart from health care provided at government hospitals. The CSMBA was a well-managed medical benefit association, but when it was appointed the compulsory medical benefit association for white public servants, government intervention affected the financial viability of the organization, despite the payment of a state subsidy.