Insights

The Era of Behavioural Economics

By Barry Childs   2017 saw the Nobel prize in Economics awarded to Richard H. Thaler for his wide ranging work in the area of behavioural economics. While he is not the first to receive the award for work in this field, his writings and contribution to making behavioural economics more accessible have done us all a great service. We had the pleasure of hosting our third Foresight dialougues event a few weeks back with Behaviour as the theme. Topics included the impact of behaviour on fraud and fraud mitigation, what influences our medical scheme purchasing choices, addictive behaviour, anti-selective behaviour [...]

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Closer to Home: The Affordable Care Act and NHI

By Gary Kantor   The battle between Democrats and Republicans over the Affordable Care Act (ACA) – Obamacare – is of interest to observers worldwide. Despite obvious differences between South African and US health care systems, the unfolding drama there may be relevant to health care policy makers locally as we consider our own high stakes health reform initiative, NHI – National Health Insurance. The failure to achieve universal health coverage in the United States despite the country’s wealth and its enormous total national spend on health care, (around 18% of GDP – over $3 trillion) marks it out as different from [...]

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Policy and its (failed) implementation

Jodi Wishnia February 2017   South Africa, like many middle income countries, has robust and technically sound policies but struggles with their implementation. In my opinion, the first step to understanding how the Life Esidimeni crisis and many other similar incidents happened, is to understand the disjuncture between policy and its implementation. Using the Life Esidimeni (LE) case as an example, we can look at South Africa’s Mental Health Care Act, 2004 and its strategic plan, relevant from 2013 to 2020[1]. The strategic plan places a heavy focus on the concept of deinstitutionalisation. This means that there is a push to reintegrate mentally [...]

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Bad Apples and a Just Culture

Gary Kantor February 2017 It’s tempting to conclude that MEC Mahlangu, Dr Selebano and Dr Manamela are the sole culprits in this distressing affair. After all, to quote Professor Makgoba, their “fingerprints” are “peppered throughout the project”.  This would be comforting, for if we simply get rid of the culprits – those who are to blame – the problem is solved, and a tragedy like this will never recur.   Unfortunately, even if the three officials are permanently removed from their positions, patients in the Gauteng public health system are unlikely to be safer the next day and thereafter. Let’s explore why.   In health [...]

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Magical mommy kisses and the meaning effect

Having a seven-year old son means an almost endless series of grazes, knocks and bruises. My go-to response is to kiss it better. Even though he is rapidly shrugging off believing in Santa Claus and the tooth fairy (“it’s a tooth mouse mom, fairies don’t exist”), both he and I happily participate in the illusion of magical mommy kisses. But is it an illusion? For most of these minor injuries mommy kisses do seem to help. The explanation that makes the most sense to me is what researchers refer to as the meaning effect or meaning response:   “We define the meaning [...]

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The Signal Model: Throwing Light into Dark Corners

Murky territory Have you ever tried to compare the value-for-money that you get from two different medical scheme options? Whether you’re a consumer trying to choose an option, a broker advising clients or a technical marketing actuary, you will know that it is impossible to come to an objective conclusion by simply studying the benefit brochures.  Simply tallying which benefit option offers richer benefits is insufficient, particularly since you need to make a comparison on multiple benefits. The question that needs to be asked is “what is the value of those additional benefits and how does it compare to the [...]

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Why Actuaries Need “Street View”

I remember playing with Google Maps for the first time. It was startling to get a zoomed-out view of your neighbourhood, your city, your country. In business-school speak this is the view from 30 000 feet. And this is the view that being an actuary affords you. We have the ability to look at the patterns formed by data, to join the dots in unexpected ways, to rise above the detail. Working in healthcare this means thinking about questions like how to allocate resources across provinces, or figuring out ways of measuring healthcare quality, or using statistical methods to benchmark [...]

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It’s Complicated

The first round of public hearings held by the Health Market Inquiry during February and March of this year have, at the same time, been both fascinating and frustrating to watch. I certainly don’t envy the panel members. There is an enormous amount of information to process. This includes thousands of pages of written submissions, presentations and transcripts. It is the task of the inquiry to process all of this information, distil it down to the facts and then make recommendations. This is by no means an easy task: not all of the information provided by stakeholders is relevant to [...]

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Round one of the HMI: Interpreting X-rays

Shivani Ranchod 11 March 2016   The first round of public hearings for the Competition Commission Health Market Inquiry (HMI) wrap up today. For those of us who have been obsessively following the proceedings it will be a relief to have a break before the next round. As one commentator tweeted: “Spellbound”. It has been a fascinating series of presentations from across the private health sector: medical schemes, administrators, hospital groups, individual patients, brokers, regulators, policymakers and various practitioners groups. If you were to read the media reports the overwhelming sense you would get is of an industry in trouble. Unsurprisingly the media [...]

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