Anti-selection in voluntary health insurance markets: A focus on medical schemes in South Africa

IF 0.1 Q4 BUSINESS, FINANCE
R. Harris, S. Besesar
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Abstract

This paper discusses the role of voluntary health insurance (VHI) in relation to public healthcare systems and universal health coverage (UHC). The paper explores why VHI markets are particularly susceptible to anti-selection. As the largest VHI market globally, the South African medical scheme market is then examined in detail. An overview of the history of the South African healthcare system provides insight into the development of the medical scheme market. Thereafter, an analysis on the impact of anti-selection on medical schemes is conducted using the experience from the largest open medical scheme in the market. The results demonstrate how existing risk mitigation measures are ineffective at protecting medical schemes from the effects of anti-selection, and the subsequent negative impacts of this phenomenon on the industry and the healthcare system as a whole. The paper discusses alternative mechanisms for addressing anti-selection risks and concludes that mandatory membership in some form has the potential to improve the sustainability of medical schemes in South Africa, which will in turn support the country’s transition towards UHC.
自愿健康保险市场中的反选择:对南非医疗计划的关注
本文讨论了自愿健康保险(VHI)在公共医疗系统和全民健康保险(UHC)中的作用。这篇论文探讨了为什么VHI市场特别容易受到反选择的影响。作为全球最大的VHI市场,南非医疗计划市场将受到详细审查。通过对南非医疗体系历史的概述,可以深入了解医疗计划市场的发展。然后,利用市场上最大的开放医疗计划的经验,分析了反选择对医疗计划的影响。研究结果表明,现有的风险缓解措施在保护医疗计划免受反选择影响方面是无效的,以及这一现象对行业和整个医疗系统的负面影响。该论文讨论了解决反选择风险的替代机制,并得出结论,以某种形式强制加入有可能提高南非医疗计划的可持续性,这反过来将支持该国向全民健康保险过渡。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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South African Actuarial Journal
South African Actuarial Journal BUSINESS, FINANCE-
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