Public health care expenditure is expected to reach 5.8% of GDP in 2030 from an average of about 3.7% over the 2006-10 period (de la Maisonneuve and Oliveira Martins, 2013). This is the largest increase among the BRIICS countries and close to the highest among OECD countries. Around 40% of the public health care spending rise will be due to demographic trends against an average of 30 and 20% 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.