Mutuality and solidarity in healthcare in South Africa

This paper uses Wilkie's definitions of mutuality and solidarity to review the history of private healthcare in South Africa. The vision for a future unified national healthcare system is given and the phases of reform are outlined. The first phase of reforms has been completed and these are contextualised in terms of a return to solidarity principles. The elements of a planned social healthinsurance system are described and it is shown how income cross-subsidies will further entrench the principles of solidarity. In the past, healthcare actuaries largely supported mutuality principles. The implications for the actuarial profession are suggested. Keywords : healthcare, medical schemes, social solidarity, community rating, minimum benefits, social health insurance, risk equalisation South African Actuarial Journal Vol. 5 2005: 135–167