Tag Archives: South Africa

Medical underwriting and risk adjustment practices: South Africa

Health insurance models vary from country to country. As highlighted in our first series of articles on international health markets, governments often dictate the role of private and public health insurance within any country. Milliman has produced a new series of blogs focused on the medical underwriting and risk adjustment practices of eight countries: Australia, Ghana, Ireland, New Zealand, Saudi Arabia, South Africa, Spain, and United Arab Emirates. This is the fifth article in our series.

South Africa’s health system consists of a large public sector and a smaller but fast-growing private sector—these two sectors are essentially disconnected and exist in parallel. There are also a few non-government not-for-profit organizations that are considered part of the system. These three sectors form the national health system under the stewardship of the Minister of Health.

The public health system is a tax-funded system that provides free primary healthcare to all citizens. At hospital level, payment for services is means tested—in 2011, anyone with an annual income over ZAR36,000 (about US$4,000) has to pay partly and those with annual incomes over ZAR72,000 (about US$8,000) must pay in full. The model is based on a referral basis for escalating a patient through the levels of care. The entry point is a community nurse who may seek guidance from a general practitioner.

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