The role of risk equalization in moving from voluntary private health insurance to mandatory coverage: the experience in South Africa

McLeod, Heather; Grobler, Pieter Alexander

doi:10.1108/s0731-2199(2009)0000021010

Cited by 9 publications

(7 citation statements)

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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%

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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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Section: Resultsmentioning

confidence: 99%

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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“…Other covariates considered for predicting average number of visits to a GP included a select list of chronic diseases The following 10 selected chronic conditions are those most prevalent with the medical schemes: 23 , 29 Hypertention Hyperlipideamia Asthma Coronary artery disease HIV Hypothyroidism Epilepsy Diabetes mellitus type 1 Diabetes mellitus type 2 Cardiac failure. …”

Section: Methodsmentioning

confidence: 99%

Visit to general practitioners as a proxy for accessing chronic benefits by members of medical schemes, South Africa

Willie

Gantsho²

2012

Afr. j. prim. health care fam. med.

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BackgroundPrescribed Minimum Benefits is a list of conditions that all medical schemes need to cover in full, and includes a select of chronic conditions. Chronic conditions affect people's lifestyles and require ongoing management over a period of years for long-term survival.ObjectivesThis study examined the association between prevalence of selected chronic diseases and health service use, in particular visits to general practitioners (GPs) by medical scheme members.MethodThis was a retrospective study on medical schemes data. The median imputation method was employed to deal with missing and unreported chronic diseases prevalence. Multivariate logistic regression analysis was employed to assess effects of chronic disease prevalence, age stratum and scheme size on GP visits per annum.ResultsThe study showed that prevalence of asthma was significantly associated with more than three GP visits (OR = 1.081; 95% CI = 1.008–1.159), as was prevalence of type 2 diabetes (OR = 1.087; 95% CI = 1.027–1.152), whilst prevalence of hyperlipidaemia (OR = 0.92; 95% CI = 0.875–0.97) was more likely to be associated with less than three GP visits. Prevalence of hypertension was associated with more than three GP visits per year (OR = 1.132; 95% CI = 1.017–1.26).ConclusionThis study shows that scheme size, prevalence of chronic diseases such as asthma, type 2 diabetes, hyperlipidaemia and hypertension are related to GP visits. GPs and managed care programmes employed by schemes should give special attention to certain disease states with high prevalence rates in an effort to better manage them.

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“…The debate about having a comprehensive mandatory health insurance scheme has been ongoing since 1994, and involves various stakeholders, including political parties, government departments, medical schemes, private providers, and civil-society organisations (McIntyre, 2010, p. 23-36). The plan was initially mooted by the African National Congress (ANC) while it was still a party fighting for political freedom in the early 1990s, and was contained in its Health Plan of May 1994 when the ANC led the newly elected democratic government (McLeod and Grobler, 2009). However, the ANC felt that it would have been premature to introduce such a system under conditions of serious fragmentation and financial instability, particularly in the medical-schemes market (Tshabalala-Msimang, 2008, p. 8).…”

Section: South Africa’s Healthcare System Historymentioning

confidence: 99%

Healthcare systems: typologies, framework models, and South Africa’s health sector

Katuu¹

2018

IJHG

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Purpose A healthcare system in any country is rarely the product of one logical policy-making experience, but rather a manifestation of many years of historical development. The purpose of this paper is to examine the characteristics, components, and variables of South Africa’s healthcare system in the context of global patterns. It leverages a dynamic period in South Africa since 1994, and applies a comparative health systems analysis to explain where the country’s healthcare system is, and where it is potentially going. Design/methodology/approach This paper reviews literature related to South Africa’s healthcare system, outlines its historical development, and discusses three fundamental challenges experienced in the country. This paper also reviews the literature on healthcare system typologies and identifies three framework models that have been used to categorise national healthcare systems since the 1970s. This paper then discusses the categorisation of South Africa’s healthcare system in these models, in comparison to Canada and the USA. Findings This paper finds that the framework models are useful tools for comparative analysis of healthcare systems. However, any use of such typologies should be done with the awareness that national healthcare systems are not isolated entities because they function within a larger context. They are not static, since they are constantly evolving with many nuances, even with very similar healthcare system categorisations. Originality/value This paper charts the trajectory of change in the South African healthcare system, and demonstrates that the change process must keep internal conditions in mind if the outcome is to be successful. Imitating policies of countries with well-functioning systems, without regard to local realities, may not work, as the government attempts to usher in changes within a short span of time.

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The role of risk equalization in moving from voluntary private health insurance to mandatory coverage: the experience in South Africa

Cited by 9 publications

References 1 publication

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

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

Visit to general practitioners as a proxy for accessing chronic benefits by members of medical schemes, South Africa

Healthcare systems: typologies, framework models, and South Africa’s health sector

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