DESK REVIEWS | 02.02.06.02. Are private health insurance markets regulated?

DESK REVIEW | 02.02.06.02. Are private health insurance markets regulated?

Yes. There is the National Regulatory Agency for Private Health Insurances and Plans (Agência Nacional de Saúde Suplementar – ANS), that is linked to the Ministry of Health and is in charge to regulate the private health insurances and plans sector in Brazil  (National Regulatory Agency for Private Health Insurances and Plans, 2019a).

References:

National Regulatory Agency for Private Health Insurances and Plans. (2019a). Agência Nacional de Saúde Suplementar. https://www.gov.br/ans/pt-br

 

The Insurance Authority is an insurance regulator independent of the Government. It modernises the regulatory infrastructure to facilitate the stable development of the Hong Kong insurance industry, it provides better protection for policy holders, and it complies with the requirement of the International Association of Insurance Supervisors (Insurance Authority, n.d.).

References:

Insurance Authority. (n.d.). History. Retrieved from https://www.ia.org.hk/en/aboutus/role/history.html

The Insurance Regulatory and Development Authority of India (IRDA) has the duty to protect the interests of the policyholders to regulate, promote, and ensure orderly growth of the insurance business and re-insurance business in India (Insurance Regulatory and Development Authority of India (IRDA), 2016). For the health insurance sector, IRDA has attempted to improve service standards and has issued guidelines standardising 42 most used definitions/terms/conditions in health insurance policies. The guidelines also include definitions of twenty-two common critical illnesses covered under various health insurance policies in India (IRDA, 2016).

References:

Insurance Regulatory and Development Authority of India (IRDA). (2016). Guidelines on Standardization in Health Insurance.

Private insurance companies operate under the supervision of the Ministry of Finance (House of Representatives, 1992) (Mahendradhata et al., 2017, p.44). Otoritas Jasa Keuangan Republik Indonesia is the regulatory body for private insurance and re-insurance companies. Peraturan OJK no. 71/POJK.05/2016 regulates on the financial health of the companies, determining areas of investments allowed with its assets, governing its liabilities, etc. (Otoritas Jasa Keuangan Republik Indonesia, 2016). Note that there are also some non-profit insurance companies with sharia type products (Mahendradhata et al., 2017, p.96).

References:

Mahendradhata, Y., Trisnantoro, L., Listyadewi, S., Soewondo, P., MArthias, T., Harimurti, P., & Prawira, J. (2017). The Republic of Indonesia Health System Review (Vol. 7, Issue 1). https://apps.who.int/iris/bitstream/handle/10665/254716/9789290225164-eng.pdf

Otoritas Jasa Keuangan Republik Indonesia. (2016). Peraturan Otoritas Jasa Keuangan (POJK) No 71 Tentang Kesehatan Keuangan Perusahaan Asuransi dan Perusahaan Reasuransi. 50. https://www.ojk.go.id/id/kanal/iknb/regulasi/asuransi/peraturan-ojk/Documents/Pages/POJK-tentang-Kesehatan-Keuangan-Perusahaan-Asuransi-dan-Perusahaan-Reasuransi/SAL-POJKKesehatan Keu PA PR -.pdf

Private insurance markets are regulated by the Insurance Act (2001). This act applies to all insurance intermediaries and all insurers, whether established in or outside of Jamaica that carry on in Jamaica, these include:

  1. Ordinary long-term insurance
  2. Property insurance
  3. Accident insurance
  4. Liability insurance
  5. Pecuniary insurance
  6. Motor vehicle insurance
  7. Marine, aviation, and transport insurance
  8. Industrial life insurance
  9. Sickness and health insurance
  10. Other classes of insurance business as may be prescribed by the Minister by order, subject to affirmative resolution.

Regarding sickness and health insurance, eligibility is decided based on the insurance company. However, the Insurance Act stipulates that making or permitting any unfair discrimination between persons will be a violation of the act and deemed as unfair trade practices. Health claims paid are determined by the contract.

The Insurance Regulatory Authority is the body in-charge of managing all insurance firms including the medical insurance firms under the Insurance Act (Amendment) 2006, CAP 487 (Government of Kenya, 2010).This body is in charge of setting the rules and regulations that govern all insurance companies in Kenya. However, it is not clearly stated whether private insurance health firms have specific market regulations set. Insurance companies use their own resources and strategies to reach a wider market, with particular interest in those employed.

References:

Government of Kenya. (2010). The Kenya Constitution, 2010. Kenya Law Reports. http://www.kenyalaw.org/lex/actview.xql?actid=Const2010

Yes, the National Insurance and Bonds Commission, a decentralised entity of the Ministry of Health, regulates the companies regarding the operation and administration of these services. The Federal Commission for the Protection against Health Risks (Comision Federal para la Protección contra Riesgos Sanitarios, COFEPRIS), regulates all health-related issues in all private institutions from board certification of medical doctors to malpractice in hospitals, health clinics, etc. COFEPRIS also regulates these matters within public (Ministry of Health) and Social Security institutions.

The Reserve Bank of New Zealand is the prudential regulator and supervisor of all insurers carrying on insurance business in New Zealand and is responsible for administering the Insurance (Prudential Supervision) Act 2010 (RBNZ, 2020).

References:

RBNZ. (2020). Household debt. Reserve Bank of New Zealand website. Available from: https://www.rbnz.govt.nz/statistics/key-graphs/key-graph-household-debt.

The private healthcare market is characterised by (i) an unregulated pricing environment; (ii) healthcare expenditure that is driven by medical practitioners (i.e., via their own practice or via referral for further investigation); and as a result, (iii) a supply-induced demand that reflects a lack of competition in the market of medical scheme administrators (Competition Commission SA, 2018). Health consumers are largely disempowered with no method to assess the value of services that schemes procure on their behalf, and hence no leverage to hold managed care organisations to account (Competition Commission SA, 2018). Due to the lack of regulations in this area, consumers are also unable to choose a medical aid scheme and cover plan based on value-for-money. Consumers often trade affordability with a reduction in the range of benefits covered by scheme plans offered, where schemes compete ‘cosmetically’ on products that are available on cost-ranges, instead of value-for-money (Competition Commission SA, 2018).

References:

Competition Commission SA. (2018). Health market injuiry. Available from:  http://www.compcom.co.za/wp-content/uploads/2018/07/Executive-Summary.pdf