Actuarial Prudential Regulation in Health Coverages: The Role of the Actuary (from a LATAM Perspective)

Latin American health systems problems (and those of Argentinean health system failures, which were the motivation for our core research, in particular) affect consumers in several dimensions, ranging from financial to delays or failure to provide coverage, and so leading to aggravation of health conditions). Our Center’s research covers several aspects of regulation in several Latin-American Health Systems. It started with a description of the Argentinian system, a comparison with other Argentinian systems’ prudential regulations (such as banking and insurance), later on we added a comparison with other Latin-American systems, and now is evolving into the development of what we believe could be a “best practice” prudent regulation for the different types of entities that conform the system.

We have covered the following topics:

• Argentinean health system structure, including all types of entities, from universal basic health coverage to individual health insurance (and governmental coverages, union coverages, prepaid medicine, etc.)
• Comparison of Latin-American health systems regulation, including available data to evaluate them
• Aspects of risk management, pricing, technical provisions, investment, solvency, among others. The role actuaries (which nowadays, and opposite to what we believe is necessary, is minor) is key in our research and proposals. Currently, we are researching on these aspects:
• Proposition of a prudent regulation for a health insurance sector with multiple types of entities, both private and public, and with different base regulation

• Role of the actuary, including its supervisory role
• Market discipline.

Including the data related problems (provision, disclosure to regulator and market). Even tough our research focuses on solving the problems that the Argentinean health system has, it could potentially benefit other systems which have characteristics such as public – private interactions, strongly interrelated coverages from different agents, overlapping of coverages, political risks, economic risks, among others.

Lessons learnt from COVID-19 and its impact on health system response to a pandemic scenario are also being incorporated in our work.