It's going to be another exciting year for this industry thanks, in part, to the re-emergence of national health insurance (NHI) on the agenda. This has already led to a split in the ranks of the Board of Healthcare Funders (BHF), the medical aid industry body.

Discovery, the scheme said to have left the BHF because of its stance on the looming NHI, is now spearheading the formation of a splinter industry body. Many other medical aids are supportive of the rebel group, but Thokozani Magwaza, CEO at Sechaba, a medical administrator, has his doubts. "The jury is still out, they (Discovery) tried to do this before but failed."

For its part, Discovery ascribes its controversial exit from the BHF to corporate governance concerns but denies being anti-NHI - a government plan to fund and provide decent health care to all South Africans including the poor, a segment subjected to the chaotic state hospitals where the word "decent" doesn't feature that strongly thanks to perennial underfunding and staff shortages.

According to actuarial and health-care expert academic Prof Heather McLeod, there is an up to seven-fold (per capita) disparity in what is spent in the public sector - which caters for no less than 35m people - versus the private.

Private hospital groups embrace the NHI, while many in the medical aid industry oppose it because they feel it will trigger the demise of their industry. But that's taking it to the extreme. Still, why are medical aids fretting if they are simply not-for-profit entities?

Whatever their reason, the anti-NHI schemes should remember the low-income medical scheme, the health-care charter and the risk equalisation fund - all dead in the water. NHI itself was due for implementation in 2006. Three years later, it remains a concept.

Meanwhile, this year many captains of the industry moved. Of note are Discovery principal officer Jacky Mathekga - who resigned to pursue personal interests - and Patrick Masobe, the former registrar of medical schemes, who surprisingly quit after a year-long sabbatical. Now at Liberty Health, he finds himself in the unusual position of competing for business with the likes of Discovery.

This was the year in which Old Mutual Healthcare died a quiet death, with Prosperity losing its medical aid clients. Minnow schemes such as Humanity, Solvita and Renaissance.

But you have to hand it to Discovery. Its growth has been nothing less than phenomenal, in a stagnant market - if you exclude the effect of players such as the Government Employees Medical Scheme (Gems), which stands out for breaking into the unloved low-income market.

Discovery's growth has been mainly at the expense of the likes of Bonitas, Fedsure, Medshield and Oxygen. In fact, at Oxygen things are getting worse as the fund continues to report operating losses and a shrinking membership base.

Bonitas has also been suffering at the hands of Discovery and has lost its government-employed members to Gems, which since inception in 2006 has grown to cover 1m members.

In 1999, Discovery's membership base sat at 542 450 and it cost an average of R10 500/year per member in premiums (or a total of R2,36bn), which made it more dear than Bonitas and Medshield.

Today Discovery has nearly 2m members, says marketing executive Hylton Kallner. Just last year, Discovery added more than 300 000 people - that's almost twice the size of Oxygen - and since the beginning of this year a further 350 000, some from Pathfinder.

He says the scheme also recorded an operating surplus of R997m.