The implementation of a South African National Health Insurance, combined with the potential of price reforms, has the potential to adversely affect the profitability of the health care industry. This could force management to look at ways to better understand the causal link between costs and the activities that drive costs. The study aimed to determine the extent of ABC use in health care facilities in South Africa, what the perceived and actual benefits are of adopting ABC and what other management tools and techniques are considered important. A structured questionnaire was sent to a target population, to which 51% of recipients responded. The results revealed that the rate of ABC adoptions has increased from 1.2% in 1994 to approximately 46% today. The growth in ABC adoptions and the high level of ABC adoption in relation to hospitals in the USA and Ireland indicate that the hospital industry in South Africa acknowledges the value ABC can add.