Private Health Insurance and Social Health Insurance
- Developing Markets - An International Short Course
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10 - 14 October 2005
Cape Town, South Africa
Introduction
The World Health Organization in December 2004 urged all member
countries to consider mechanisms for pooling financing for
healthcare, including Social Health Insurance, in order to
achieve universal coverage.
The Health Economics Unit at the University of Cape Town offers
a 5-day short course addressing the changing role of health in-
surance in low- and middle-income countries. The course focuses
on the financial management of risk pools in diverse settings
covering a broad spectrum of insurance arrangements including
community-based health insurance, private voluntary insurance
for the formal sector and social or national health insurance.
Objectives
The objective is to give participants an understanding of the
choices in the financing of healthcare and issues in private
healthcare financing arrangements. The course combines the theo-
retical principles with practical illustrations, using examples
from the private sector in South Africa as well as examples from
other African countries. Although specific country examples may
be used, the principles conveyed in the case studies have broad
relevance. A core learning objective will be understanding the
risks in pooled financing arrangements and techniques for manag-
ing those risks. The course will provide an understanding of the
design and pricing of benefits and the impact of managed care on
healthcare delivery costs. It also addresses the key questions:
who should be covered by health insurance and how should provid-
ers be paid. Possible pathways towards universal coverage such
as in social or national health insurance arrangements will be
discussed.
Target Audience
The course will be of interest to:
. Health economists.
. Doctors and health professionals.
. Actuaries and statisticians in healthcare financing.
. Policy-makers and public sector officials dealing with
public-private mix issues.
. Researchers dealing with strategic healthcare financing
issues.
. Health insurance and hospital administrators who need an
understanding of the developing framework for Social
Health Insurance both in South Africa and other African
countries.
. Trustees and managers of health insurance schemes or
Pooled financing arrangements.
. Candidates for the Masters in Public Health programme at
UCT or UWC.
Course Content
. Market Failure in Health Care as a Rationale for Health
Insurance
This session discusses the deviations from market principles in-
herent in the allocation of medical services. We look at both
the supply of medical services and the demand for health care
and show how health insurance can address the so-called problem
of market failure.
. Efficiency and the Economics of Health Insurance
The optimal design of any form of health insurance depends on
the availability and distribution of information between the in-
surers, the clients and the suppliers of medical services. This
session examines strategies to design insurance contracts to
avoid undesirable outcomes such as ex-ante or ex-post moral haz-
ard and adverse selection.
. Equity Considerations in Health Insurance
The private sector has often been associated with inequities in
access to health services. This session addresses the issue by
introducing tools to assess the equity impact of different modes
of health services financing and provision within health insur-
ance arrangements.
. Actuarial Foundations of Health Insurance: Understanding
Risk
An understanding of risk factors in pooled arrangements is
needed for pricing and risk management. South African studies
are used to illustrate factors that affect the price of health-
care, such as age, gender, income and chronic disease.
. Types of Health Insurance
Most countries have some form of coverage of health risks. This
session gives an overview of various forms of health insurance
and their characteristics. Sometimes different forms of private
coverage exist in parallel. This is illustrated by discussing
the demarcation between indemnity business (medical schemes) and
non-indemnity business (health insurance) in South Africa and
the rationale for their regulatory separation.
. Rationing in Health Insurance: Benefit Design as a Ration-
ing Tool
Healthcare resource allocation is framed as a rationing problem.
The forms of rationing are discussed and benefit design is ex-
plored as a rationing tool using South African examples.
. Needs in Relation to Ill Health
A session on health care needs in relation to ill health high-
lights additional criteria for the design of benefit packages.
. Rationale and Implementation of Minimum Benefits
The Oregon system of rationing healthcare is outlined and the
application of that methodology is shown as the basis for deter-
mining minimum benefits for healthcare in the private sector in
South Africa. The links to constitutional rights and public sec-
tor care are shown. Practical issues experienced with a system
of minimum benefits are illustrated.
. Pricing Health Insurance
The fundamentals of pricing for healthcare are explained. The
pricing of minimum benefits in South Africa is used to demon-
strate the principles of pricing in a community-rated environ-
ment.
. Dealing with the Risk of Variability
The nature of risk in pooled arrangements is explored in more
detail. Techniques for managing the risk of variability include
the use of large risk pools, minimum solvency margins, the use
of reinsurance and the transfer and sharing of risk with health-
care providers in managed care.
. Social Health Insurance or National Health Insurance
The choice between Social Health Insurance and National Health
Insurance is illustrated using results from an analysis of the
potential impact in South Africa.
. Non-formal sector options (CBHI, MHI)
Health insurance options for the informal sector, such as commu-
nity-based health insurance (CBHI) or mutual health insurance
(MHI), and criteria for their feasibility in different environ-
ments will be discussed. The models will be illustrated with
case studies from different African countries.
. Risk Equalisation Techniques
Risk equalisation or risk adjustment techniques have wide appli-
cation in healthcare, from provider stabilisation to public sec-
tor budgeting to stabilisation of risk pools in a competitive
environment. The experience of developing the South African Risk
Equalisation Fund is used to illustrate the principles of risk
equalisation.
. Evaluating Insurance Choices in Different Contexts
This session summarises policy makers' choices along the spec-
trum of insurance arrangements from completely privately funded
to public insurance. The implications of the different design
elements will be assessed on the basis of equity and efficiency
criteria.
Course Fee
This course is offered for non-degree purposes. Ideally, par-
ticipants will have an acceptable undergraduate degree in medi-
cine, economics, social science, finance, accounting, law or ac-
tuarial science.
The fee for the 5-day course including lunches and teas is ZAR
7,500 (local participants) / USD 1,250 (international partici-
pants).
On completion of the course, participants receive a certificate
of attendance.
Registration for the course starts 4 July 2005. Places are allo-
cated to appropriate applicants on a first come - first served
basis. The closing date for applications is 4 September 2005.
Applicants will be informed of the outcome of their application
shortly after the closing date.
For further details and application forms contact:
Ms. Andiswa Sifile
Health Economics Unit
School of Public Health and Family Medicine
Tel: +27-21-406-6558
Fax: +27-21-448-8152
mailto:asifile@heu.uct.ac.za
For content-related and academic queries:
Dr Michael Thiede
Tel: +27-21-406-6754
mailto:mthiede@heu.uct.ac.za
Associate Professor Heather McLeod
Tel: +27-28-572-1933
mailto:hmcleod@iafrica.com
--
Fiorenza Monticelli
Health Systems Trust
HealthLink Editor
Tel: +27-31-307-2954
Fax: +27-31-304-0775
mailto:fiorenza@hst.org.za
http://www.hst.org.za