public health care expenditure is expected to reach of gdp in from an average of about over the period de la maisonneuve and oliveira martins this is the largest increase among the briics countries and close to the highest among oecd countries around of the public health care spending rise will be due to demographic trends against an average of and for the other briics and oecd countries respectively the south african health care system is highly fragmented and mostly privately financed the poor are particularly vulnerable to catastrophic health expenditure