Risk equalisation and voluntary health insurance: The South Africa experience

McLeod, Heather; Grobler, Pieter Alexander

doi:10.1016/j.healthpol.2010.06.008

Cited by 10 publications

(10 citation statements)

References 2 publications

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“…In our study, 83% of patients had more than two comorbidities that required additional exercise rehabilitation and other lifestyle intervention considerations 13. This finding is in keeping with data from other studies and elucidates why such lifestyle intervention programmes should be patient-centred and presented by a multidisciplinary team.…”

Section: Discussionsupporting

confidence: 90%

“…Yet the majority of patients presenting with a chronic disease have multiple associated comorbidities. For example, in South Africa, more than 50% of private medical insurance members have more than one chronic disease and some have up to 11 simultaneous chronic conditions 13. Thus, new models of prevention are urgently required and should be included in the undergraduate medical curriculum 14.…”

Section: Introductionmentioning

confidence: 99%

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Description and implementation of U-Turn Medical, a comprehensive lifestyle intervention programme for chronic disease in the sport and exercise medicine setting: pre–post observations in 210 consecutive patients

et al. 2014

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Description and implementation of U-Turn Medical, a comprehensive lifestyle intervention programme for chronic disease in the sport and exercise medicine setting: pre–post observations in 210 consecutive patients

et al. 2014

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“…The NHIS in Nigeria has not implemented ‘risk equalisation’ among HMOs – a process that involves financial transfers from insurance companies with a low-risk membership to those with older or sicker members as practiced in controlled market insurance schemes. An example of such mechanisms in developing countries is that of South Africa [13,14]. …”

Section: Resultsmentioning

confidence: 99%

“…This framework can be used to present the degree of integration or segmentation (both vertically and horizontally) of the four components of any healthcare system; namely revenue collection , pooling , purchasing and provision . This general approach is now widely used in the literature [13,14] but the addition of diagrams facilitates easy assimilation for the reader of how the four functions are either linked or separated from one another.…”

Section: Methodsmentioning

confidence: 99%

Assessing equity in health care through the national health insurance schemes of Nigeria and Ghana: a review-based comparative analysis

Odeyemi

Nixon

2013

Int J Equity Health

128

139

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BackgroundNigeria and Ghana have recently introduced a National Health Insurance Scheme (NHIS) with the aim of moving towards universal health care using more equitable financing mechanisms. This study compares health and economic indicators, describes the structure of each country’s NHIS within the wider healthcare system, and analyses impacts on equity in financing and access to health care.MethodsThe World Bank and other sources were used to provide comparative health and economic data. Pubmed, Embase and EconLit were searched to locate studies providing descriptions of each NHIS and empirical evidence regarding equity in financing and access to health care. A diagrammatical representation of revenue-raising, pooling, purchasing and provision was produced in order to analyse the two countries’ systems.ResultsOver the period 2000–2010, Ghana maintained a marked advantage in life expectancy, infant mortality, under-5 year mortality, and has a lower burden of major diseases. Health care expenditure is about 5% of GDP in both countries but public expenditure in 2010 was 38% of total expenditure in Nigeria and 60% in Ghana. Financing and access are less equitable in Nigeria as, inter alia, private out-of-pocket expenditure has fallen from 80% to 66% of total spending in Ghana since the introduction of its NHIS but has remained at over 90% in Nigeria; NHIS membership in Nigeria and Ghana is approximately 3.5% and 65%, respectively; Nigeria offers a variable benefits package depending on membership category while Ghana has uniform benefits across all beneficiaries. Both countries exhibit improvements in equity but there is a pro-rich and pro-urban bias in membership.ConclusionsMajor health indicators are more favourable in Ghana and overall equity in financing and access are weaker in Nigeria. Nigeria is taking steps to expand NHIS membership and has potential to expand its public spending to achieve greater equity. However, heavy burdens of poverty, disease and remote settings make this a substantial challenge. Ghana’s relative success has to be tempered by the high number of exemptions through taxation and the threat of moral hazard. The results and methods are anticipated to be informative for policy makers and researchers in both countries and other developing countries more widely.

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“…The private healthcare insurance market in South Africa is voluntary and accounts for 60 per cent of total healthcare expenditure, but it serves only 16 per cent of the South African population -those with higher incomes (Centre for Development and Enterprise, 2011;Council for Medical Schemes, 2010/11). Approximately five-million formally employed people in South Africa are not yet insured for healthcare (McLeod & Grobler, 2010). It is essential that they enter the private healthcare insurance market to ensure growth and future sustainability of the private healthcare industry.…”

Section: Introductionmentioning

confidence: 99%

Product innovation of private health insurers in South Africa and the impact of entrepreneurial orientation

Urban¹

2013

SAJEMS

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Recognising that health insurer product innovation plays a critical role in aligning incentives among all stakeholders in the healthcare value chain, this study investigates the relationship between the level of health insurer product innovation and entrepreneurial orientation (EO). Taking cognisance of the importance of external collaboration between health insurers and healthcare service providers, the study is able to diagnose perceptions of strategic regulatory factors and their impact on levels of EO. The focus of the study is on the demand (financing) and supply (healthcare delivery) structures of the healthcare value chain, incorporating health insurers, health insurer administrators and healthcare service providers. A conceptual model is formulated on the basis of literature and tested using confirmatory factor analysis. The results indicate that EO at organisational level is a strong predictor of health insurer product innovation and that external collaboration between health insurers and healthcare service providers is a weak predictor of health insurer product innovation. Practical implications are that both the supply and demand side structures indicate that the restructuring of relationships between health insurers and healthcare service providers is a necessary driver for collaboration in terms of health insurer product innovation progress and success. Healthcare executives need to work with, and actively lobby regulators to ignite both demand and supply side innovation activities in the healthcare value chain of the private healthcare industry of South Africa.

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Risk equalisation and voluntary health insurance: The South Africa experience

Cited by 10 publications

References 2 publications

Description and implementation of U-Turn Medical, a comprehensive lifestyle intervention programme for chronic disease in the sport and exercise medicine setting: pre–post observations in 210 consecutive patients

Description and implementation of U-Turn Medical, a comprehensive lifestyle intervention programme for chronic disease in the sport and exercise medicine setting: pre–post observations in 210 consecutive patients

Assessing equity in health care through the national health insurance schemes of Nigeria and Ghana: a review-based comparative analysis

Product innovation of private health insurers in South Africa and the impact of entrepreneurial orientation

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