1. An Historical Study of Trends in Medical Schemes in South Africa: 1974 to 1999

Prepared by Preeta Rama and Heather McLeod
July 2001

This monograph presents a pictorial overall view of private-sector medical schemes in South Africa over the period 1974-1999. The material is the result of the compilation of a database using the Annual Reports of the Registrar of Medical Schemes and statutory Registrars returns.

[Full text (371 KB)]

2. An Investigation into Healthcare Costs in the Last-Year-of-Life 

Prepared by Prabashini Moodley and Heather McLeod
July 2001

Health costs are shown in USA studies to be highest in the last year of life. This monograph examine studies from other parts of the world, to determine a methodology to apply to South African data. The methodology is applied to eight medical schemes over a four year period, 1997 to 2000. The data are also used to investigate the ratio of medical costs of those who died to those who survived.

[Full text (287 KB)]

3. Risk equalisation methodologies: an international perspective

Prepared by Neil Parkin and Heather McLeod
September 2001

In order to preserve social solidarity in healthcare, governments impose regulation of health funders to entrench community rating and open enrolment.  Community rating and open enrolment are normally accompanied by mechanisms for risk equalisation between the funds operating in that market. This monograph provides details of a selection of the risk-equalisation methodologies in use internationally in 2001, and describes their role within the relevant health systems.

[Full text (482 KB)]

4. The Impact of AIDS on Orphanhood in South Africa: A Quantitative analysis

Prepared by Leigh Johnson and Rob Dorrington 
October 2001

The purpose of this monograph is to present an analysis of the impacts of the HIV/AIDS epidemic on the number of orphans in South Africa. The primary focus of the monograph is on the quantification of the orphan population, and the ASSA2000 Orphans model is presented as a tool for projecting the size and demographic profile of this population. Numbers of orphans are projected under various scenarios, and the capacity of the South African system to deal with the growth in orphan numbers is briefly assessed. 

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6. An Analysis of the Competitive Environment for Low-Cost Options in Medical Schemes 

Prepared by Shivani Ranchod, Heather McLeod and Samora Adams
December 2001

This monograph presents a working definition of low-cost options and considers the need for these options in medical schemes in South Africa. Detail is provided of the products currently available in the market. The distinguishing characteristics of theses options are identified, in particular their use of capitation and risk-sharing agreements with providers. The need for even lower cots products is identified and recommendations are made for their design. 

[Full text (361 KB)]

7. Chronic Medicine Benefits in Medical Schemes: An Analysis of Benefit Design in 2001 and Changes since the Introduction of the Medical Schemes Act, 1998 

Prepared by Shivani Ranchod and Heather McLeod
December 2001

This monograph considers the changes in chronic medicine benefits in open medical schemes over the period 1999 to 2001. Details of current chronic medicine benefit design are given and an example of innovative thinking in the design of a restricted medical scheme is discussed.

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8. HIV Risk Factors: A Review of the Demographic, Socio-economic, Biomedical and Behavioural Determinants of HIV Prevalence in South Africa 

Prepared by Leigh Johnson and Debbie Budlender
January 2002

The purpose of this monograph is to identify the most significant demographic, socio-economic, biomedical and behavioural determinants of HIV risk in South Africa. It also aims to determine the relationships between these factors, and to show how these factors apply in workforce populations. It combines a literature review of studies conducted in South Africa into the effects of various factors on rates of HIV infection, and a statistical analysis of four major South African data sets.

[Full text (331 KB)]

10. The Cover Provided for HIV/AIDS Benefits in Medical Schemes in 2002 

Prepared by Andrew Stein, Heather McLeod and Zackie Achmat
July 2002

The monograph presents the findings of a survey carried out amongst medical schemes to investigate the extent and nature of the beneftis covering HIV/AIDS provided by medical schemes. The research is of particular relevance to policy makers interested in deciding the coverage of a Prescribed Minimum Benefits package.

[Full text (405 KB)]

11. Estimation of mortality using the South African Census 2001 data 

Prepared by Rob Dorrington, Tom Moultrie and Ian Timus
2004

This monograph derives estimates of recent mortality in South Africa taking into account the most recent demographic data gathered by the
2001 census. Various deficiencies in the census data and the extensive editing thereof are highlighted, leading to the conclusion that it is not possible to produce reliable estimates of infant and child mortality from these data. However, adult mortality rates were produced (for each sex, nationally, by population group and by province) by making use of the deaths from the population register together with those reported by households in the census and the census population estimates. These rates show a clearly increasing trend in mortality rates, concentrated in specific age groups that are strongly suggestive of the increases that one might expect due to the impact of HIV/AIDS on mortality. The report concludes by presenting illustrative life tables together with probable maxima and minima for various commonly used indices of mortality.

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12. Estimation of fertility from the South African Census 2001 data 

Prepared by Tom Moultrie and Rob Dorrington
2004

This monograph presents estimates of fertility from the South African census conducted in 2001. The quality of the data on women's lifetime and recent fertility are subjected to strenuous examination, and are found to be uniformly (and severely so) deficient. Extensive use was made of imputation rules, which are shown to be biased on many dimensions. Careful application of various direct and indirect techniques to the data results in estimates of fertility that are robust and plausible, insofar as the resulting age distribution of fertility is found to be fundamentally similar to that estimated from earlier demographic sources (the 1996 Census and the 1998 DHS) and the levels of fertility represent the continuation of previously identified trends.Estimates of fertility are derived for each population group, and by province. The national level of fertility is estimated to be 2.8 children per woman in 2001.

[Full text (492 KB)]