Abstract
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 equalisationSouth African Actuarial Journal Vol. 5 2005: 135–167
Highlights
1.1 David Wilkie, in a few sentences in a talk at a conference at the Royal Society in 1996 (Wilkie, 1997), introduced the terms ‘mutuality’ and ‘solidarity’ to English actuarial literature
This paper uses the pegs of mutuality and solidarity to explain the regulatory changes of the 1990s and to describe the elements that still need to be implemented for an social health insurance (SHI) system in South Africa
1.5 Section 5 outlines the phases of reform and the social-security context for the future healthcare system envisaged for South Africa
Summary
3.1 INEQUALITIES BETWEEN PUBLIC AND PRIVATE SECTOR 3.1.1 Public and private healthcare in South Africa had evolved separately in the apartheid era. The Department of Health (unpublished) summarises this history as follows:. “Until 1994 the health system was splitting markedly into a public sector focused exclusively on the indigent or those without medical scheme cover and private sector focused on the young and healthy employed population.”. 3.1.2 Figure 1 illustrates the inequalities that persisted in health expenditure and resources between the public and private sectors in South Africa in 2003, despite attempts since 1994 to ensure ‘healthcare for all’, as the Department of Health slogan exhorts. 3.2.2 The extent of the work to reintegrate the public and private sectors into an efficient single system is immense. In a review of the performance of health systems, the World Health Organisation (unpublished), ranked South Africa at number 175 out of 191
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