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

H. McLeod, P. Grobler
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引用次数: 10

Abstract

OBJECTIVE The South African health system has long been characterised by extreme inequalities in the allocation of financial and human resources. Voluntary private health insurance, delivered through medical schemes, accounts for some 60% of total expenditure but serves only the 14.8% of the population with higher incomes. A plan was articulated in 1994 to move to a National Health Insurance system with risk-adjusted payments to competing health funds, income cross-subsidies and mandatory membership for all those in employment, leading over time to universal coverage. This chapter describes the core institutional mechanism envisaged for a National Health Insurance system, the Risk Equalisation Fund (REF). A key issue that has emerged is the appropriate sequencing of the reforms and the impact on workers of possible trajectories is considered. METHODOLOGY The design and functioning of the REF is described and the impact on competing health insurance funds is illustrated. Using a reference family earning at different income levels, the impact on worker of various trajectories of reform is demonstrated. FINDINGS Risk equalization is a critical institutional component in moving towards a system of social or national health insurance in competitive markets, but the sequence of its implementation needs to be carefully considered. The adverse impact of risk equalization on low-income workers in the absence of income cross-subsidies and mandatory membership is considerable. IMPLICATIONS FOR POLICY The South African experience of risk equalization is of interest as it attempts to introduce more solidarity into a small but highly competitive private insurance market. The methodology for considering the impact of reforms provides policymakers and politicians with a clearer understanding of the consequences of reform.
风险均等在从自愿私营医疗保险转向强制性保险方面的作用:南非的经验。
长期以来,南非卫生系统的特点是财政和人力资源分配极度不平等。通过医疗计划提供的自愿私人健康保险约占总支出的60%,但只服务于14.8%的高收入人口。1994年拟订了一项计划,转向国家健康保险制度,向相互竞争的保健基金支付风险调整后的款项、收入交叉补贴和所有就业人员的强制性会员资格,逐步实现全民覆盖。本章描述了为国家健康保险系统设想的核心体制机制,即风险均衡基金(REF)。出现的一个关键问题是改革的适当顺序以及考虑可能的轨迹对工人的影响。方法描述REF的设计和功能,并说明对竞争健康保险基金的影响。以不同收入水平的家庭收入为参考,论证了不同改革轨迹对劳动者的影响。研究结果风险均摊是在竞争性市场中建立社会或国家健康保险制度的关键制度组成部分,但需要仔细考虑其实施顺序。在没有收入交叉补贴和强制性成员资格的情况下,风险均等对低收入工人的不利影响是相当大的。对政策的影响南非风险均等化的经验值得关注,因为它试图将更多的团结引入一个规模小但竞争激烈的私人保险市场。考虑改革影响的方法为政策制定者和政治家提供了对改革后果的更清晰理解。
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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