A regulatory capture explanation of South Africa's private health insurance legislation

Abstract

Private healthcare financing in South Africa has undergone several regulatory reforms, the most recent of which saw the enactment of the Medical Schemes Act No. 131 of 1998. The stated reforms, most especially open enrolment and community rating, were touted by the government as necessary to address the undesirable effects of adverse selection. However, it was never questioned whether in fact adverse selection is a feature of the South African medical schemes landscape. Adverse selection is found to be absent. Thus, government’s supposition that adverse selection, as a consequence of the deregulation that took place during the late 1980s and early 1990s, is responsible for the deterioration in medical scheme coverage for the elderly, unhealthy or poor is fallacious. Since the ostensible reason for the current legislation does not stand up to scrutiny, regulatory capture is offered as the plausible alternative explanation for the promulgation of the current legislation governing medical schemes business.