Abstract: This paper investigates catastrophe risk for South African life insurers by considering the additional deaths that could arise from a 1-in-200 year mortality shock. Existing South African academic research on catastrophic risk has mostly focused on property losses and the resulting impact on property insurance companies. Life catastrophe risks have not been extensively modelled in a South African context. Local research would be beneficial in terms of quantifying these catastrophic risks for South African life insurers, and would assist firms when assessing their own catastrophe mortality solvency requirements under the new Solvency Assessment and Management (SAM) regime by providing a summary of data relating to various past catastrophes. In this paper we model a wide range of catastrophes to assess such mortality risk faced by life insurance companies in South Africa. An extensive exercise was undertaken to obtain data for a wide range of catastrophes and these data were used to derive severity and frequency distributions for each type of catastrophe. Data relating to global events were used to supplement South African data
where local data were sparse. Data sources included official government statistics, industry reports and historical news reports. Since, by nature, catastrophic events are rare, little data are available for certain types of catastrophe. This means there is a large degree of uncertainty underlying some of the estimates. Simulation techniques were used to derive estimated distributions for the potential number of deaths for particular catastrophic events. The calculated overall shock for the national population was 2.6 deaths per thousand, which was lower than the SAM Pillar 1 shock of 3.2 deaths per thousand for the same population

Abstract:The aim of this paper is to investigate the expenditure incurred by health insurers arising from the provision of benefits during the 12 months preceding a beneficiary’s death. Concern is expressed in parts of the international literature about the extent of resources directed towards those at the end of life, particularly given increased longevity and technological advancement. Two types of investigation are discussed: first, a comparison of costs in the last year of life with costs in earlier years prior to death and, second, a comparison of decedent and survivor costs within a calendar year. Within each investigation, further detailed analyses were performed with particular emphasis on the distribution of last-year-oflife costs by age and category of expenditure. A South African dataset is used to illustrate the suggested methodology. The average cost in the last year of life is found to be 3.3 times higher than the average cost in the second last year of life. Average decedent costs are found to be 17.85 times higher than average survivor costs in 2012, on a risk-adjusted basis. The majority of these costs (83.35% in 2012) form part of the Prescribed Minimum Benefit package.

Abstract: The Sunday Times Discovery Healthiest Company Index Survey collected a dataset of 13578 responses from corporate employees in 101 companies. This dataset has been used to assess the prevalence of self-reported modifiable health-risk factors and the association with chronic conditions. The analysis indicates that there is a greater likelihood of an individual reporting a chronic condition where their lifestyle risk factors are outside of the healthy range. This suggests that there are opportunities to manage the costs of health insurance, medical expenses and productivity losses by applying risk management tools aimed at addressing modifiable risk factors.

Abstract:In this paper, the methodology underlying the graduation of the mortality of members of group schemes in South Africa underwritten by life insurance companies under group life-insurance arrangements is described and the results are presented. A multivariate parametric curve was fitted to the data for the working ages 25 to 65 and comparisons are made with the mortality rates from the SA85–90 ultimate rates for insured lives and the ASSA2008 AIDS and demographic model. The results show that the mortality of members of group schemes is lower than that of the general population, mortality decreasing with increasing salary, as would be expected. For males it was found that there were differences in mortality rates by industry for a given salary band, whereas for females these differences only occurred in the lower salary bands. Furthermore, there is evidence of the healthy-worker effect at ages 60 and above, where the mortality rates appear to level off or even decrease as age increases. This contrasts with the mortality rates from the SA85–90 ultimate rates for insured lives and the ASSA2008 AIDS and demographic model, which increase exponentially.

Abstract: An accurate measure of the change in the price of medical-scheme cover over time is necessary to inform health and social-security policy, and would provide consumers, employers and the regulator with a useful benchmark. A medical-scheme contribution index based on gross contributions to open medical schemes is constructed using the Paasche formula and a sample of schemes for the period 2006 to 2010. The results of the index indicate a 17,48% increase in real contributions over the period.

Abstract: In this paper, the mortality of members of group schemes underwritten by South African life insurance companies is investigated. The research provides some indication of the level or mortality of this population as a whole, which apart from being useful for costing group schemes in future could be used, to the extent that these data represent the mortality of those in formal employment, in the costing of a national retirement scheme. Rates of mortality are investigated by several demographic factors such as age, sex, salary and industry of employment.

Abstract:Access to healthcare is considered to be a basic human right. This paper explores the concept of access to public healthcare, with a particular focus on affordability, accessibility and accommodation. Furthermore, it highlights certain issues around the concept of access in the South African setting, by analysing the results from the General Household Surveys (2002–2009). Affordability of healthcare services and the positioning of the facilities were not identified as being key barriers to access. Instead, other aspects, such as accommodation to the patients’ needs and acceptability of services received had greater significance and should be prioritised in terms of any proposed healthcare reforms.

Abstract:This paper presents the results of an investigation into whether age or work status are statistically significant determinants of the change in the consumption rate at and in retirement. This research used data from the Income and Expenditure Survey 2005–2006 for households comprising one or two adults. It was found that gifting and non-healthcare consumption, which includes gifting, are not influenced by age or work status. Certain households were found to have higher healthcare
consumption after retirement than before retirement. This result challenges the belief that retired households have lower consumption than working households, all other things equal, and may therefore necessitate an upward adjustment to retirement adequacy goals.

Abstract: The globalisation of the financial services industry and the increasing complexity of insurance products, among other factors, have led to the development of new regulatory systems for insurers globally (and, in particular, in South Africa). The primary intention of these systems is to protect the interests of policyholders by ensuring that insurance companies remain solvent in most foreseeable circumstances. In South Africa, new regulation, known as Solvency Assessment and Management (SAM), is expected in 2015, but this regulation is to apply only to insurance companies and not to medical schemes. This paper considers the implications of the application of capital requirements under Quantitative Impact Study 1 to the measurement of capital adequacy in South African medical schemes. Data from 2006, 2007 and 2008 were used to parameterise the non-SLT health-underwriting risk module (i.e. the risk module relating to health-underwriting risk that is not similar to life techniques), which was then used to determine the level of economic capital that schemes would have been required to hold in 2009. The results showed an overall
reduction in the capital requirements of medical schemes, as compared with the current statutory minimum requirements, and therefore an increase in the proportion of medical schemes that are found to be solvent.