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. ” Emma Thompson 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 consumer, feasible for the service-provider, yet at the same time competitive in the market. This research is very useful because it enables the reader to understand exactly how pricing of health insurance is being done currently and enlightens the reader on the limitations of current pricing strategies being employed.
It is also eventually supposed to suggest a better pricing method. The other issue that this research is going to address concerns the HIV positive potential clients. We obviously know that they indeed require more medical care, but we also need to know exactly by how much, and if the fact that they are HIV positive impacts their chances of getting affordable healthcare insurance, considering the many developments that are coming around such that people live healthy positive lives (The impact of Anti-Retroviral Treatment-ART, adapting healthy lifestyles).
LITERATURE REVIEW Definition of important terms Health Insurance: Supakankunti (2000) defines health insurance as “… a means of financial protection against the risk of unexpected and expensive health care. ” Price: The “value” that is paid for a good or service received (David Marlowe) Pricing: the process of determining what a company will receive in exchange for its products David Marlowe, [Strategic Marketing Concepts, Ellicot City, Maryland] assessed the roles of pricing as being: * To create an “image” for a product or service * To generate revenues and income.
* To give customers incentives or disincentives to use a product or service * To capture market share or squeeze out a rival (health insurance in Zimbabwe could be found guilty on trying to use this reason of pricing on one another) A study conducted in Rwanda found that 350 HIV-positive outpatients visited the hospital 10. 9 times on average as opposed to 0. 3 times for the general population. (Nandakumar, Schneider and Butera, 2000). Another study in Zimbabwe showed, for instance, that hospital care for HIV/AIDS patients was twice as expensive as that for the non-HIV/AIDS patients.
Calculations by the World Bank (1999) suggested that the effect of HIV/AIDS on total health care costs is likely to be quite large, even in countries that are spared the most serious epidemics. As HIV/AIDS increases the demand for health care, it will tend to drive up the effective price of health care as well, amplifying the impact on total health-care spending. All these are possible indications that surely HIV status has to have a weighting on the premium charged for health insurance.
Expenditures on health services also differed according to gender, income, place of residence and the ability to mobilize non-household resources to pay for care. I am yet to find a research that was previously done on the quantified effect of the HIV status in relation to pricing of health insurance. SCOPE This research and results will be confined to the Zimbabwean situation only, and will specifically concern those health insurance companies legally registered under the Insurance Act. I intend to use data for the time-period 2009 the most recent data that will be available.
METHODOLOGY-I will be conducting my research using information concerning the whole of Zimbabwe. Data collection: I intend to make use of comprehensive questionnaires to insurers, AIDS activists, AIDS victims. I also have to take the following precautions during my data collection process: * The data I intend to collect is sensitive in nature; hence high confidentiality will be required. * Care should be given that so that the questions I ask are not likely to be harmful to my respondents. * I should be mindful of the circumstances of respondents, such as the setting time, the venue, interview duration, etc.
* I should not cause harm through unauthorized use of secondary data for example plagiarism, piracy, etc. * I should exercise honesty and accuracy Data processing: This involves the editing and coding of gathered data for analysis. I might make extensive use of the Microsoft Excel program to assist in the processing and analysis. Data analysis: This is tabulation and evaluation of data into usable information. I will have to do qualitative and quantitative analyses. Data presentation: Here I should be able to communicate my findings in an understandable manner.
This research will be exposed to a number of limitations that might require highlighting. * Sometimes legislations imposed by the insurance regulator (IPEC) may not be enforced * Data collected by various AIDS activist organizations which I intend to use for my research may not be accurately representative of Zimbabwe’s true situation, as many people are still in fear of disclosing their HIV statuses. * I might face time constraints in trial to fully conduct the research as I have other academic commitments. * I might face resistance and non-cooperation from my intended sources of data and other vital information.
* Financial constraints TIMETABLE* This is how I intend to distribute the time committed to this research: Stage of Research| Time frame| Intensive Literature Review and Research design| Present – Mid November| Supervisor consultation| 20 November| Data collection| December| Data processing| 1 January – 10 January| Data Analysis| 11 January – 18 January| Supervisor consultation| 20 January| Recommendations formulation and conclusion| February| *In this timetable, I have already made provisions for possible delays.