DESK REVIEWS | 02.02.06. Private health care insurance

DESK REVIEW | 02.02.06. Private health care insurance

Data from the National Regulatory Agency for Private Health Insurances and Plans showed that around 23% of the population of Brazil purchased private health care insurance by the end of 2018 (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

According to the National Health Profile (CBHI, 2019), about 37.2% of the population was covered by any health insurance in 2017-18, while 62.8% of the population remain uninsured. Of those insured, 78% were covered by public insurance and the rest by private insurance  (CBHI, 2019).

References:

Central Bureau of Health Intelligence (CBHI). (2019). National Health Profile. Ministry of Health & Family Welfare, Government of India. Available from http://www.cbhidghs.nic.in/showfile.php?lid=1147

In 2017, life/health insurance made up 6.66% of all financial products owned by Indonesians aged 18 and older. However, this figure dropped to 4.47% in 2018 (Mahendradhata et al., 2017, p.44). (Please note the percentages are out of all respondents and there were 23.59% and 24.86% of people who did not have any forms of financial products in 2017 and 2018, respectively).

In 2013, BPJS established a coordination of benefits with some of the leading private health insurance providers to provide a top-up option for middle- and high-income members of the JKN, which may increase the uptake of private insurance in Indonesia (Mahendradhata et al., 2017, p.44). In 2019, BPJS and 11 insurance providers (members of Forum Asuransi Kesehatan Indonesia) signed a Coordination of Benefit agreement to simplify the process of adding on private insurance policies to their existing BPJS schemes (Kartika & Walfajri, 2019).

References:

Kartika, H., & Walfajri, M. (2019). Gandeng perusahaan asuransi, peserta BPJS Kesehatan bisa naik kelas gratis.

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

Private health insurance growth has stagnated over the years and slight decrease was even seen from 2009 to 2014, where the 32 private health insurers collectively covered 1.15%  from 1.17% of the Kenyan population (Kazungu & Barasa, 2017).

References:

Kazungu, J. S., & Barasa, E. W. (2017). Examining levels, distribution and correlates of health insurance coverage in Kenya. Tropical Medicine & International Health, 22(9), 1175–1185.  https://doi.org/10.1111/tmi.12912

While the market for private health insurance has increased in the past decade and more multinational insurance companies have entered the market, the last available estimate from the OECD is 4% of total population purchasing private health care insurance (OECD, n.d.).

References:

OECD. (n.d.). Health data. Retrieved March 16, 2020, from https://data.oecd.org/healthres/health-spending.htm

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.