HEALTH INSURANCE PRICING AND THE EFFECT OF WRITING HIV/AIDS INTO THE BUSINESS: Striking a balance between indiscrimination, risk management and competitiveness.
Despite significant advances in HIV treatment and education, people living with HIV and AIDS have had a difficult time obtaining private health insurance and have been particularly vulnerable to insurance industry ‘abuses’. What are the insurers’ excuses for these ‘abuses’? What changes can begin to improve access to insurance for people living with HIV/AIDS and other disabling conditions and help people with these conditions retain the coverage they have? Are they so much of a high risk that incorporating them into the business portfolio would lead to them having to pay too high a premium; otherwise the business will be exposed to an unfavourable business risk? This paper seeks to look into all these and other issues. Health insurance,sometimes referred to as Medical Aid Schemes,are schemes that help pay your health related fees like doctor’s fees, medical costs, hospital fees and so on. As a policy holder you pay a monthly fee to the medical aid company, which allows you as the policy holder to be medically covered up to a certain amount. Medical schemes have numerous advantages, chief among being the ability to access medical attention even when financial situations are less than favourable. The quality of care is another advantage of medical schemes. The doctors and hospitals that medical schemes refer their clients to must meet certain standards as prescribed by the law in any location a medical scheme might operate within. This fact alone encourages a medical scheme to provide the best medical care that it can. Most care givers associated with medical schemes are private clinics, doctors, and specialists. There are over 10 such health insurance companies in Zimbabwe.
“I have had lots of friends who've been affected by Aids and a very good friend of mine, Oscar Moore, died of Aids… and of course he was a man living in a very rich culture with a wealthy family who was able to afford health care.”
OBJECTIVES OF THE STUDY
This research seeks to address these, among other, issues:
1. How are health insurance products being currently priced? 2. Is this appropriate?
3. How do they treat risky business like HIV/AIDS? – interview some HIV patients: who have been denied health insurance before? 4. What does regulation say about this kind of business? 5. How can they incorporate this type of business without running into adverse risk? 6. Suggest an appropriate pricing model for health insurance. NULL HYPOTHESIS: HIV/AIDS business writing significantly increases risk exposure for health insurers, and will lead to a considerably high premium charge, if it is to be accepted.
JUSTIFICATION/RATIONALE OF THE STUDY
Although gravely underrated by many, especially in this our still careworn economy, health insurance tends to be one of the most fundamental of needs required by many a people, from all diverse social classes. Importance of health insurance
* Manageable childcare
* Although insurance can be expensive it can cause a bigger burden not having insurance when serious injuries occur * General peace of mind
* Uninsured people receive less medical care and less timely care. * Uninsured people have worse health outcomes.
* Relief of a fiscal burden from self and family
Source: Institute of Medicine (IOM). 2001. Coverage Matters: Insurance and Health Care Different people, with different lifestyles and medical conditions exhibit differing risks to the health insurance givers. An obvious example is that a diabetic person will certainly require medical attention more frequently than a non-diabetic. It is for this reason that there needs to be an investigation on exactly how this service is priced and whether the pricing methods used are appropriate/fair to the...
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