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Healthcare (South African Healthcare System [SIMB] 41NbQKPYPrL._SX355_…

- - - - Financial inclusion
      - Access
  - - - Violence
      - Road traffic accidents
    - - TB
      - HIV
    - - Lifestyle diseases
      - Hypertension
      - Diabetes
  - - - Governing legislation and regulation
      - For-profit and not for-profit
      - Ability to underwrite
      - Schemes provide indemnity for medical expenses
      - Insurance policies pay benefits to policyholders not providers
      - Clear marketing, product naming and warnings required of insurance products to avoid confusion - demarcation
- - - - Covered
      - Uncovered
    - - Funder
      - Supplier
      - Regulator
  - - - Direct affect on the policyholder
      - Ability to earn same level of income
      - Other members of household affected
  - - - No with-profits products
      - Protection only and not savings [except long term care]
      - Group version readily available
      - Age and Health Risk have clear relationship [but may not be priced for in SA]
      - Underwriting crucial [anti-selection and moral hazard abundant]
      - Perils abundant
      - Claim events not clear
      - Waiting periods, exclusions, excesses and copayments are common
      - Regulation abundant
    - - Endless covered perils
      - Human focussed
      - Regulation very different
      - Highly emotive and litigious
      - Environment changing rapidly
      - Complex product deisgn
      - Solidarity vs mutuality
- - - - Big differences between countries
      - Mostly funded from national budget
      - Protect Nation's Health
      - Access to Healthcare seen as basic human right
    - - Complement or alternative to state cover
      - Compulsory or voltunary
      - Services driven by market
  - - - Premium may be linked to ability to pay or overall risk of pool
      - Principles
        
        Open enrolment
        
        Community rating
        
        Prescribed Minimum Benefits
  - - - Medical Schemes
      - Government
    - - Medical Schemes
      - Adminstrators
      - Managed care organisations
    - - From public, employers, taxpayers
      - By State or Schemes
    - - Hospitals
      - Practioners
      - Pharmacies
- - - - Leads to supplier induced demand
  - - - Having insurance makes people less likely to take steps to improve their health
      - Treatment choice allocated by doctors
    - - Use-it-or -lose it mentality
    - - Co-payments, deductibles
      - Discourages unnecessary use of health goods and services
      - Exclusions
- - - - Disease
      - Stress
      - State of mind
      - Sleep
      - Nutrition
      - Cultural factors