Mutuality and solidarity in healthcare in South Africa

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 equalisation

South African Actuarial Journal Vol. 5 2005: 135–167