Heather McLeod

     

Body, Mind, Soul,

Earth

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Risk Equalisation in South Africa

Healthcare Financing, Policy and Reform

An early paper on the need for risk equalisation in South Africa was by Neil Söderlund and Solani Khosa, published in Health Policy and Planning in 1997.

 

 

 

A chapter on risk equalisation was included in the Department of Health submission to the Taylor Committee in 2002.

• Department of Health (2002), Inquiry Into the Various Social Security Aspects of the South African Health System. Policy Options for the Future., 14 May 2002.

• Chapter 7 : Risk Equalisation.

 

 

 

 

 

Consultative Forum, Task Teams and International Review

 

• Department of Health (2003) Opening Address to the Consultative Forum On Risk Equalisation by Dr Ayanda Ntsaluba, Director-General, Department of Health. Midrand, 10 July 2003.

 

 

 

 

• McLeod H., Matisonn S., Fourie I., Grobler P., Mynhardt S. and Marx G., (2004) The Determination of the Formula for the Risk Equalisation Fund in South Africa. Prepared for the Risk Equalisation Fund Task Group on behalf of the Formula Consultative Task Team, January 2004.

• For technical information see Sections 8 and 9. Appendices N, O and Q.

 

 

 

 

 

 

• Armstrong J., Deeble J., Dror D.M., Rice N., Thiede M., Van de Ven W.P.M.M. (2004) The International Review Panel Report to the South African Risk Equalization Fund Task Group. 16 February 2004.

 

 

 

 

 

 

Risk Equalisation Technical Advisory Panel Reports on Methodology

 

• RETAP (2005) Methodology for the Determination of the Risk Equalisation Fund Contribution Table [Base 2002, Use 2005]. Recommendations by the Risk Equalisation Technical Advisory Panel to the Council for Medical Schemes.  Recommendations Report No. 1 of 2005. 10 February 2005.

 

• RETAP (2006) Methodology for the Determination of the Risk Equalisation Fund Contribution Table 2006 [Base 2002, Use 2006]. Recommendations by the Risk Equalisation Technical Advisory Panel to the Council for Medical Schemes.  Recommendations Report No. 7. Adopted at RETAP Meeting 26 January 2006.

 

• RETAP (2007) Methodology for the Determination of the Risk Equalisation Fund Contribution Table 2007 [Base 2005, Use 2007]. Recommendations by the Risk Equalisation Technical Advisory Panel to the Council for Medical Schemes.  Recommendations Report No. 9. 17 April 2007.

 

 

 

 

From 2008 onwards, the REF Contribution Table has been called the REF Weighting Table and the tables were produced by the Council for Medical Schemes. There were however technical problems with those tables and a document explaining the concerns is available on request.

 

 

 

 

Academic Papers on Risk Equalisation in South Africa

 

The two papers below were presented to the Risk Adjustment Network, an international network of researchers, in Dublin in 2008. The first provides an overview of the South African health system and outlines the methodology for determining the risk equalisation formula. The second paper describes the experience with including chronic disease in the risk equalisation formula.

 

 

 

 

 

 

 

• McLeod, H., & Grobler, P. (2009). The role of risk equalization in moving from voluntary private health insurance to mandatory coverage: the experience in South Africa. In D. Chernichovsky & K. Hanson (Eds.), Advances in Health Economics and Health Services Research. Vol. 21: Innovations in Health System Finance in Developing and Transitional Economies. Emerald Books.

 

 

 

 

 

 

• McLeod, H., & Grobler, P. (2010). Risk equalisation and voluntary health insurance: The South Africa experience. Health Policy, 98 (1), 27–38.

 

• Armstrong, J., Paolucci, F., McLeod, H., & van de Ven, W.P.M.M. (2010). Risk equalisation in voluntary health insurance markets: A three country comparison. Health Policy, 98 (1)  39-49.

 

 

 

 

• McLeod, H. (2012) The Role of Risk Adjustment in the Equitable Financing of National Health Insurance in South Africa. Development Southern Africa. Volume 29, Number 5, December 2012. 636-656.

 

 

 

 

 

PubMed citation Soderlund & Khosa (1997) Emerald Books 2009 DOH Report 2002 pdf small DG Opening Address pdf small Formula Report 2004 pdf small Appendix N pdf small International Panel pdf small REFCT 2007 pdf small Risk Equalization SA pdf small Chronic Disease pdf small Health Policy Vol 98 (1) Development SA Vol 29 (5)