Session: 18

Health Seminar

* * *

Summary

Social health insurance and private insurance both represent mechanisms which enable the burden of the direct cost of medical care for the individual to be spread, either over a period of time rather than having to be made at the time and point of delivery, and or among a group of protected people who share the risk of costs of medical care. On the other hand, health care issues cannot be addressed without some level of government involvement. This is the idea behind the need for health policy planning and implementation.

There is a considerable number of issues involved with this process; they are of different nature and present various technical and practical degrees of complexity. Nevertheless, all agree that funding is the chief issue. There are different ways of funding for health services: government financing through taxes, social insurance, private health insurance, and direct payment for services by patients. With the exception of the last, these systems all provide an element of insurance, i.e. risk pooling or risk sharing.

Actuaries have an important role to play in the process of policy-making and funding health services, regardless the specific techniques applied and the type of organization of health delivery.

This paper reviews recent experience in this field and makes some reflections about funding health services and the degree of the actuay's involvement in this process.

Giovanna Ferrara has been an active ASTIN member: in the ASTIN Committee from 1975 to 1989, she was the ASTIN chairperson in the biennium 1978-1980. Since 1978 she is involved, as an actuarial consultant and social security expert, in technical assistance projects carried out by ILO and other International Agencies. 

Those projects, aimed at introducing, analysing or reforming social protection, concerned several countries in Africa, Asia, Central America and Polynesia. She has been charged with training courses concerning mathematical models for social security projections in China (ILO 1989) and Czechoslovakia (ILO 1992) and Morocco (CNSS 1999). She is a trainer in social security financing and economics at the ILO training Centre. 

As an independent consultant she has carried out actuarial studies for Employer Sponsored Health Insurance Plans and she is appointed actuary in a life insurance company in Italy.

Presently, in Morocco, she is helping the CNSS in implementing a computer program for actuarial projections and participating in a project financed by the World Bank relevant to the financial feasibility of health care packages for poor population.

She is member of the Istituto Italiano degli Attuari (Italy), where she is acting as a member of the Executive Board and Liaison person with IAA. She is member of ASTIN and of Association of Swiss Actuaries (Switzerland).