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 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

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.