Analytics is increasingly becoming a key tool to support informed management decisions in organisations. An organisation’s capability to make use of data analytics can enhance efficiencies and increase competitive differentiation and advantage. In the context of healthcare, analytics can support improved health outcomes and hence stakeholder value that enhances affordability and access to care. A deep understanding of analytics applications and techniques lends itself to identification of opportunities where analytics techniques are best applied. This paper introduces analytics maturity models as a tool to inform proportionally appropriate analytics applications. In this paper, a broader perspective is provided through consideration of the position on the analytics maturity curve of current techniques utilised in the healthcare system. The relationship between analytics maturity and analytics techniques in the healthcare space is then explored to demonstrate that there are opportunities for applying more sophisticated techniques to more advanced applications and hence enhance the efficiency of healthcare outcomes and health risk management.

This paper discusses the role of voluntary health insurance (VHI) in relation to public healthcare systems and universal health coverage (UHC). The paper explores why VHI markets are particularly susceptible to anti-selection. As the largest VHI market globally, the South African medical scheme market is then examined in detail. An overview of the history of the South African healthcare system provides insight into the development of the medical scheme market. Thereafter, an analysis on the impact of anti-selection on medical schemes is conducted using the experience from the largest open medical scheme in the market. The results demonstrate how existing risk mitigation measures are ineffective at protecting medical schemes from the effects of anti-selection, and the subsequent negative impacts of this phenomenon on the industry and the healthcare system as a whole. The paper discusses alternative mechanisms for addressing anti-selection risks and concludes that mandatory membership in some form has the potential to improve the sustainability of medical schemes in South Africa, which will in turn support the country’s transition towards UHC.

During the 20th century, government statistical departments in South Africa produced nine complete life tables for the white population group, seven complete life tables for the coloured population group, six complete life tables for the Asian population group and no complete life tables for the African population group. As of 2020, the South African Life Tables 1979/1981 for the white population group are still used in capitalising pensions in terms of the Compensation for Occupational Injuries and Diseases Act No. 130 of 1993. Similarly, the South African Life Tables 1984/1986 for the white population group are still used extensively in damages calculations by South African actuaries. This paper provides a historical record of the nine complete life tables for the white population group and provides a forecast of those tables to 2020. The aim of the forecast is to provide an estimate for current white population mortality rates which could then serve as a non-racial mortality basis for damages claims. It also aims to complement the work of demographers in their development of new population tables based on more sophisticated demographic techniques.

Members of defined-contribution retirement funds may be able to make choices that affect their retirement outcomes. The benefit statement is considered a key resource in this process, and trustees and administrators may design these statements specifically to inform and persuade members to make appropriate choices to improve their retirement outcomes. For a statement to be theoretically effective at informing members it should be effective at communicating the inherent risks, be appropriate for the audience, have meaningful and realistic illustrations, use reasonable and consistent assumptions and show sensitivity to these assumptions, be balanced and complete, include a statement of principal assumptions and definitions of key terms and outline the options available. For a statement to be theoretically persuasive it should use emotion appropriately, identify behaviour to change, identify the member’s needs and create a link between these needs and the behaviour to change, be positively framed, personalised and appropriately timed. These characteristics can be used to develop a framework to assess the theoretical effectiveness of benefit statements. This framework was applied to a small sample of administrator benefit statements to assess their effectiveness. When member data from one fund were analysed, it was found that improving the theoretical effectiveness of the benefit statement for this fund was not sufficient to improve the contribution rate. This merits a larger scale nvestigation.Keyword: Benefit statements; defined-contribution; persuasive communication; informative communication

In the past decade, the topic of microinsurance has received much attention from researchers around the world as the drive to alleviate persistent global poverty intensifies. Although microinsurance is a powerful tool that can be used to assist in the fight against poverty by acting as a safety net for policyholders, the problem of claims fraud is a serious threat to its long-term sustainability. Analysis of the existing literature reveals a severe shortage of research into the problem of microinsurance claims fraud, even though we have found that it poses a greater threat in microinsurance than regular insurance. In this paper we highlight the problem of claims fraud in low-income markets and we explain how fraud has the potential to make microinsurance initiatives unsustainable. After establishing that action is needed to combat fraud in microinsurance, we briefly present a number of fraud mitigation techniques that have been successful in conventional insurance. However, certain characteristics that differentiate microinsurance from regular insurance reveal that most of these fraud combating approaches are not appropriate to microinsurance; the proportionately higher costs of identifying claims fraud relative to policy size, the lack of data and the lack of resources experienced by microinsurers render these methods impractical and unaffordable in the context of microinsurance. We proceed to demonstrate the workings of a statistical method known as Principle Component Analysis of Ridit Scores (the Pridit method), initially developed by Brockett et al. (2002) which has been shown to effectively identify fraudulent claims without the need for a training sample. The method can thus easily be applied by microinsurers to assist in the detection of claims fraud. While this method of fraud detection is not without limitations, it may provide a pragmatic and cost-effective way for microinsurers to begin tackling claims fraud. In this paper, the method is clearly explained by means of a worked example to help microinsurers implement the method at low cost.

A methodology for the assessment of the probable maximum loss associated with an earthquake is described and applied to the Cape Town central business district. The calculations are based on the effect of the two largest earthquakes that occurred in Milnerton in 1809 and Ceres-Tulbagh in 1969.The investigation concludes that if buildings and infrastructure in an area follow the SANS Standard10160 for seismic loading of 0.1 g, they are exposed to significant seismic risk. The main purpose of this research is not the accurate quantification of expected losses to Cape Town's infrastructure, but to raise awareness between civil engineers, the insurance industry and disaster management agencies that seismic hazard is an issue in South Africa and must be considered as a potential threat to its residents and infrastructure.

In this paper, we consider the Markovian model for the actuarial modelling of health insurance policies modified by the inclusion of durational effects (the time elapsed since entering a given state) on the aggregate payment streams, where the force of interest is a diffusion process. We derive differential equations for the first moment of the present value of the aggregate amount of benefits. We also give two examples to illustrate our results.

In prior work by the author the method of pricing the liabilities of a financial institution by means of dynamic mean–variance hedging is applied to an incomplete market that is nevertheless in equilibrium with homogeneous expectations. In subsequent work a long-term equilibrium model is developed and parameterised for the South African market. The aim of this paper is to apply the latter model to the pricing method with a view to quantifying the effects of non-additivity due to incompleteness, guarantees implicit in reasonable expectations of pension increases and the sensitivity of the price of illustrative liabilities to the parameters of the model. The application is to retirement-fund benefits in the South African market. In an unpublished application of the pricing method it was found that, except for quite short-term liabilities, the computational demands of the pricing algorithm became excessive. The main reason for this was that the algorithm calls for simulations within simulations: for each year of the term of liabilities, a large number of simulations is required, and for each such simulation another large number of simulations is required. In this article consideration is given to the reduction of the computational demands of the algorithm.Keywords: Market value of liabilities; dynamic mean–variance hedging; equilibrium market models; incomplete markets