Efficiency, productivity and returns to scale economies in South Africa’s healthcare insurance market

This article sets out a comprehensive assessment of efficiency, productivity and returns to scale economies in South Africa’s Healthcare Insurance market for the period 2011 to 2017. Economic theory suggests that there exists a relationship between the level of competition and the overall level of efficiencies within a market. For the most part, market efficiencies will be positively correlated with the level of existing market competition. This has direct implications to South Africa’s private medical scheme industry, which according to the Competition Commission’s Health Market Inquiry resembles an uncompetitive market structure. Data Envelopment Analysis was employed while conducting the study in order to estimate efficiency scores and returns to scale for both open and restricted medical schemes. The Malmquist index was employed to assess medical scheme productivity growth whereas a truncated bootstrapped regression and a logistic regression technique was employed to identify the determinants of efficiency and the probability of operating under constant returns to scale. The empirical results reveal that open medical schemes tend to be more efficient than restricted medical schemes. More so, the empirical evidence reveals that there is room for improvement of efficiencies for both open and restricted medical schemes.