 Hi guys, it's MJ, the student-actory, and I'm back here with Tiff, who studied actuarial science at Tux University, and in this discussion we're going to talk about what Tiff does day-to-day in the whole realm of actuarial science. So Tiff, please, can you welcome back and please tell us more about your day-to-day job as an actuary? Well, so I think I should actually go back and across a little bit and tell you a bit more about my other jobs before I go to my current role. I worked at a bank for a while as a business analyst and this was not in an actuarial capacity. So it was a year and a half and I highlight this because if you have an actuarial science degree and you choose not to go into the industry, you can always become a business analyst or do another sort of job, any sort of financial, whatever you want to do. So I did that for a year and a half and I was still writing exams and then I decided to go and work at a life insurance start-up and that was quite an interesting place to work. It was the only two act trees were myself and the head of actuarial and so I got a very wide broad view on all the responsibilities and everything that one has to or can do in a life insurance. So there was product development, so that's going down from what sort of benefits should we offer, what does the policy wording look like? It involves so many different teams, the legal team, the ops, can we do that? Legal team saying, well, is that legal to put this in your policy? Is it all those things? What would be an example of saying that's illegal to put in your policy? Like what are you not allowed to put it? So there's a whole lot of requirements of stuff you should put it, like that you have to put it, but so you can't go against anything that is in the long-term insurance act. So can I put this in my product? Can I say that you buy life insurance and then upon the death of your loved one, a coin is flipped and if it's heads, your benefit is doubled. If it's tails, your benefit is lost. That'd be something that we're not allowed to put in the product. So you wouldn't be allowed to put that in your product because the fundamentals are it cannot be a gamble. It's not a gamble. So if it's in any way represents a gamble, then it's just... You need the gambling license. Yeah. I'm not sure exactly, but yeah, it also has to be you have to leave the person in the same financial position or whoever the beneficiary is as they were before the event happened. So adding that dimension to it won't really fly. So another interesting thing was model development. There's pricing models, there's valuation models. There's a lot of requirements that you need to submit sort of quarterly valuations and not entirely sure. I was only there for four months. I wasn't there for the whole 12 months. Did you get fired then? I was not fired. I actually got the opportunity to move to Cape Town. So I... What was this life insurance startup doing differently? Why were they starting out? What was their business philosophy? So their business philosophy was to use alternative methods of distribution. They wanted to partner with sort of Mr. Price and sort of retailers and give life insurance through sort of the cards at Mr. Price, for example. And yeah, to try... They didn't want to compete with old mutuals and the summums of the world. They wanted to be the sort of niche market. They also had sort of a free... What would happen is if you bought another product, they'd give you six months free life insurance. And then after that, it would start kicking in your premiums. That's not... The company's not in my way of buying a chance at it. No, it's not. That's not name names. My way does something similar like that where they give you free life insurance for like a month. But you're like, well, whatever. It's quite a weird selling insurance through those channels. I mean, look, the way I see insurance is that it's a big financial decision. It's a responsible decision that people make. And they want to buy it with someone holding their hand per se. They want to go to the broker. They want to sit in the fancy office. They want to spend a day going through the different options, reading the fine print before signing it. I kind of feel like, especially you see a lot of these times you get these SMS's like, oh, buy insurance over the phone or buy it online. I don't know. Maybe it's a cultural thing, but I feel insurance is too... It's too, what could you say, too formal to be just sold at, say, a Mr. Price or something like that? Yes, I completely agree. And I feel like a lot of the target market that they were trying to reach was too financially unsophisticated to be able to completely understand how the product works. So if you give them a 10 page policy document with legal terminology, chances are they're not going to understand exactly how the product works. So another thing would be that it is... I think a lot of people would be unaware that they actually even have the product if you sell it to them in this way. Or they forget that they have this six months and they've already given their bank details. They've already committed, not signed a contract, but they've agreed over the phone. So there's all these, not ethical, it's sort of... How do you sell such a sophisticated product via this distribution channel to this specific target market? So it has its own challenges, I mean. I mean, well, already if you look at, say, the office premium, or you've got the premium that contains all the admin expenses and the brokerage fees and stuff, that makes quite a big proportion of the final premium. You've got the risk premium, which is just the actuarial risk and paying the benefit, and then all these admin expenses. And they're quite high, actuarial salaries, offices, brokerage commission, all this type of stuff. Now, when people try and sell insurance on, I think they call it micro insurance, or insurance on a much smaller level, yes, you're reducing the risk premium, but that office premium very much stays the same. Yes, there's a lot you can try to get rid of using the internet instead of a broker and clear stuff like that. But it still becomes quite an expensive product. And like you said, it's quite a sophisticated product for someone who's just getting to the grips with basic accounting and managing the income and the expenses on a month to month basis. These products are designed to look into the future and forecast different risks that can happen. And a lot of people don't want to think about all the terrible things that can happen, because I think there's even some behavioral finance thing about that. If you think about a problem, you then estimate the chance of that to be higher or something like that. It's some weird psychological thing. But let's return back to you. So after you got fired from this move to Cape Town, after you put the gambling elements in your product, and the lawyers like this is illegal, you've you've moved to Cape Town. Yes. And what did you do? What made you want to come to Cape Town? So at the time, sort of had a family moving down. So I moved on with family. And yeah, I decided what the heck Joe book. I'm young enough, and I'm crazy enough to pick up and move to another city. I also it was actually quite, quite amusing because my last day in the office of the life insurer, I didn't have a job in Cape Town. I was leaving the next day to Cape Town. And that afternoon, I got the offer from my current employer. Yes. So that was that was a good stroke of luck. So it was moving from a life insurance base to a medical space or health insurance base or quite really say health insurance in South Africa because there's a difference between health insurance and medical schemes. But anyway, a medical scheme administrator in Cape Town. And I moved into a traditional actuarial role, which in the medical scheme industry, it focuses around benefit design, pricing of benefits, contribution changes, a whole lot of that thing, that kind of stuff. So for example, you'll have a scheme coming to you and asking you. So we have a lot of people requesting or a lot of people wanting to go for a certain operation, like cataract surgery, for example. And then they'd ask you so how much is it going to cost them and how much is it going to affect their contributions? And then you'd have to go and price it based on the dates that you have. And if you don't have data, you have to look at alternative sources and then basically price that in and then sort of it gets carried through into the contributions of the members pay. Where do you get your data from? I mean, I'm sure you must have a little bit of data on hand that you guys have used before. But if you don't have specific data, like is there like an online eBay where you go and buy data or how does that work? So we are an administrator. That means we are not a medical scheme. We're a medical scheme administrator. And basically, that means that we administer quite a few schemes. And we also provide bacterial services to quite a few schemes. And this has been going on for quite a number of years. So we do have data. And it's quite a rich, rich data environment, because if you think about life insurance, you claim once and then your policy lapses or you're not relaxed, your policy is finished. Yes, it's in. Yes, it ends. With health or with with medical scheme environment, you can have multiple claims over the year. It's all short term as opposed to long term as well. You have multiple claims from multiple benefit categories. You know, some of claims can be prescribed minimum benefits. Others can be just benefits that the scheme itself offers on top of the PMBs. There's a whole lot of complexity today. And the data has all of those those aspects within it. So you'll have all the kind of names for a variety of different things as opposed to life insurance. We have the risk factors and you'll have the premium and you have the expected mortality. That's whereas, yeah, the medical scheme environment is much more data rich. And this is what you've done your your fellowship in has been in health. Yes. And was that was a difficult studying for that fellowship knowing that you worked in that environment? Or did you have to like read a bunch of notes and be like, Oh, I didn't know that I can apply that to my work. How was that procedure? So it was actually quite cool because I moved to a new team a couple of months ago before I wrote fellowship. It's a group of actuaries within the company I work for and we do we don't do traditional actual work. We do more the statistical analysis. So what I'm trying to say is I got a view on both sides of health care. So you get the traditional natural that's very like backbone, like how do we set contribution rates so that we can cover all the future claims sort of thing. And then you've got the more technical. How do we model or modeling of of of doctor profiling and more in depth things like pilots for certain systems going to doctors and and that sort of stuff. So it's more technical, it's more programming. Well, just just talking about this whole medical medical stuff. I mean, the one thing that we're seeing on the news all the time now is Obamacare, you know, especially something that Trump has shown that he doesn't like it that much. I'm not in the health space. And I don't really know Obamacare too well. And I'm just having a shot on the dog. Do you have you looked at Obamacare? Do you know what it's about? And if you have what is your opinion? So I actually haven't. What I can say about Obamacare is that they, from what I have read, they're also struggling with very big increases to their premiums. And that's super relevant in South African environment as well. But apart from that, no, haven't really looked into it. Yeah, there's a lot of politics within health care that are happening in South Africa, without having to jump over the sea. Because I mean, the last one thing about medical schemes is they're not for profit. If I understand correctly, which is weird, because I mean, your business, I take it is a business and not a charity, you know, you don't work for free. You know, so they are these administrative costs, and they always to to profitize it. But this whole philosophy of it, you know, not being for profit. And the fact that you, maybe you can correct me, like you can't turn anybody away, no matter their risk factor, and stuff like that. Do you think that that is sustainable? Or do you think that is fundamental to the whole thing of a medical scheme? So when the Medical Schemes Act came out a couple of years ago, the idea was they want to move into an environment where more people have access to health care. And by having these, you know, open enrollment, which is basically you cannot turn anyone away. You and also community rating is only, you can only charge a certain premium. You can charge a premium based on the option that you choose, whether you're an adult or child, or your family, or your income level, sorry. And so it's all about promoting universal access to health care. Because if you now are able to risk rate, you start excluding people that are too old or too sick. The people who need it the most. The people who need it the most. So and it's also based on the concept that you contribute what you can afford, that you use what you need. So I think that the problem now is that you have many different schemes. Some of them are open. That means that anyone can join them. Closed schemes mean it's sort of an employer group where only people who are employed by an employer group can join. Open schemes, there's a couple of open schemes now in the industry that have become quite competitive. And because of this community rating, you need healthy lives in your risk pool to cross subsidize the older sicker lives. And so this is caused in the medical scheme industry, certain schemes to start cherry picking healthy lives. And then you get all sorts of things like vitality to try and attract the healthier younger people. You get benefit design which favors people who like sort of offers benefits like I can't even think of anything like physiotherapy. So that will attract people who are more active and into sports and all of that. And so then you stuck with what happens is you get the schemes, some schemes are now losing members that are more healthy to the bigger ones that are cherry picking that are offering these benefits. And then the schemes that are losing the healthy members, their risk pool starts to deteriorate. So you're getting contribution increases year on year that are surpassing inflation. And this just keeps going on because the healthier members in those schemes are now realizing, okay, wait, this is not affordable. I can go to the other scheme which has these awesome benefits and it's cheaper. So then you have this whole sort of sort of selective lapsing effect. And this is called the actuarial death spiral where basically your risk pool just deteriorates to the point and your contributions just keep increasing until your scheme is no longer sustainable. And then you have to amalgamate or or liquidate the scheme. So isn't this a problem with the design? Because I mean, I see the understand the philosophy behind the medical scheme. I mean, it's almost socialist in a in a way in the sense that everyone's equal, you know, everyone's allowed to join, pay as much as you can, you know, and take as much as you need. You know, and I think that it's it's a beautiful philosophy. And I think it's, you know, it's very important when you want to provide healthcare on a macro level, you know, to the population. But as you've just been discussing, there are some fundamental flaws. I mean, it's even got a cool name, the actuarial death spiral. I mean, is there is there not a better way to provide healthcare? Like, I mean, don't we need to come together and design something completely new from the ground up when it comes to to healthcare and how to finance it? Yeah, I think that's something that the world is struggling with at the moment. I mean, you've got Obamacare, so I don't know the exact details, but it's so politically opposed. And then you've got the NHI in in the UK that is just struggling financially. And it's and I think it's it all comes down to you, you won't be able to develop or build a system that works entirely if you don't change the opinion of people because people sort of have this sort of view that they that they are entitled to certain benefits where as it's only those who are truly in need who should be entitled to those benefits. So you've got over servicing from the profession from the healthcare professionals, you've got overutilization by people when they don't actually need to go for these things. So I think everywhere we need to start re-looking and I think the medical scheme industry is doing this now because it's the contribution increases which are happening at the moment are not sustainable in the in the short term or short term sure in the medium to long term. We need to come up with more innovative ways in order to to save costs where it matters without jeopardizing the quality of care and I mean there's various well one of the what that's been happening now in the past decade or even two is that managed care organizations are being formed which is also what my company does as well as sectorial and administration and they also are very popular in the United States. So managed care organizations will try and like manage your costs in an effective way or provide so for example they'll contract with doctors in order so the doctors are on the network and they they charge these rates as opposed to doctors just charging whatever they want to set their rates as or they will look at disease management where if someone has a chronic disease they're going to make sure that this person gets their tests done that whole thing. So it's moving less into a well how do we give access to everyone to a how do we correctly manage these costs so that they don't spiral out of control and there's a lot of it's a very complicated environment and so another thing that's come up is now NHI which is due to be implemented in the next couple of years which will basically in the final stages lead to the medical scheme industry not being what it is now it will just offer supplementary services so that's also a completely different ball game now. You look at I mean let's say if you were the president of a nation or and you've got to manage your resources and you've got limited resources and you get presented with a choice one day there's this 70 year old man who's lived a good life but he now has cancer and he needs a million rand treatment and his life expectancy is going to be another five years okay but it's going to cost a million rand all you have these 10 children who desperately need a million rand across the 10 of them for an education and to get a head start in life and I know that the one is medical and the other ones you know educational but at the end of the day you know the state needs to look at how to to allocate its resources and it's quite a it's a tricky thing to say because you know I mean on one ethical side you'd think rather use that money for the 10 children because they have much more you know years and there's a higher likelihood and it makes more sense but to go to a 70 year old person and say you know sorry mate game over we're not gonna give that money to you even though you have been contributing to the system and you've been paying your taxes and you're part of this medical scheme we're only going to use that money to fund you know some children you know it is quite a yeah it's an interesting thing because there's you know no longer has it just become about you know trivial science and the maths and all that type of stuff you know have have these these ethical violins coming in I mean another thing in the medical space is you have these pharmaceutical companies where they can pursue two business plans business plan a is let's put our research into developing a cure you know a pill you take once and we heal you from your disease it's an AIDS here's a pill removes AIDS or option B is let's make a treatment for AIDS so what we do is instead of you just taking one of these pills and you're finished the disease you take this and it reduces the side effects of AIDS until you take the next pill the next week and now instead of me selling one pill to one person I'm selling a pill every single week to this person and I have a customer for life and I mean from a purely capitalistic point of view it's way more profitable to spend your money designing a treatment rather than a cure so I guess this comes down to the whole thing with with medical skins and I think why they don't want it to be for profit is because yeah there's this whole cherry picking and there is you know all these unethical because listen if if you could create the cure or you could create the treatment and you rather go the treatment route because you want to make more money from it I think that is unethical yes yeah so I can see that the medical schemes have tried to get around this by saying it's not for profit but the fact that you get all these companies that are now administrative consultants and you know they can take profit otherwise aren't or isn't that that regulation getting bypassed isn't that so there are some safeguards in place so if you go and have a look at the Council of Medical Schemes annual report they do go and list every single scheme in South Africa and they go and list how much they break down their financials basically and one of the big things is the managed care the administration all the other expenses there's been a lot of pressure on the schemes lately that that is not increasing so it has been increasing in line with inflation but hasn't been increasing excessively and one of the good benchmarks to have is that your non-healthcare expenditure that is your administration fee your actuarial services your trusty salaries all of that that must not exceed 10 percent of your gross contributions which is your savings and your your risk contributions together so if that's more than 10 percent in the council so which is sort of regulates the industry medical scheme industry they'll sort of be like no what what's happening here you know switch stuff out or whatever um yeah because i mean but the thing is publicly available model information that you can leverage off to be like well is the scheme a scheme i want to be a part of because they charge 15 percent of the gross contribution 15 percent of their gross contributions non-healthcare expenditure the thing is i mean i just i remember there was this there was a city i think it was an american city which introduced a law saying this there's a rent ceiling you cannot charge more for rent you know to try and limit the power of of the land yeah the evil landlord has all this land and people have to rent from him and because you know there's a big demand but a limited supply the prices are just going up and up and up so the city decided we're going to have a rental ceiling you cannot charge more than say a thousand dollars a month to say that's the number but the land lords want money you know just like i think most people in life we are driven by the financial side of things and so what they did is they said to people you know you can rent the room for four thousand dollars okay but if you want the key to you know lock it that's going to cost five thousand dollars a month and what they're saying is no you can borrow you know you can rent it we're meeting that minimum criteria we've just added on a value service at a ridiculous rate that has kind of undermined the whole thing and the thing is people were still prepared to pay five thousand dollars for the lock because like i said the supply was so high and the demand i'm sorry the demand was so high and the supply was so low so i look i'm very skeptical when it comes to you know regulations all these these things to try and limit it i mean with my medical aid scheme i don't think i've once checked you know how much contribution goes to whoever you know i'm very much of okay this amount i pay this is what i get i'm very much of the opinion that you know you've got medical insurance is probably especially in my stage of life it's the most important product that i need are you talking health insurance you're talking medical scheme well i'm just saying my my medical risk yes okay cool so i don't have any dependence so i don't have any life insurance i had to die i don't think people might cry but that's you know that's about it um i mean household insurance it's too expensive i'll take the risk you know someone breaks in and steals all my stuff you know that's a risk that i'll i'll self insure um okay i do have car insurance car insurance you know you kind of kind of have to have that one but like i said as far as like say saving instruments or you know putting money away for this and down to me those are you know you don't really need them at someone my age you know who doesn't have dependence but medical is the one thing that i'm very much aware of because i mean worst case scenario is you get this disease and then you're this massive burden on your family and of course they're gonna try to sell the family jill to pay for you and then you're gonna feel bad and you're probably still gonna die anyway so it i think it's such an important product i'm just yeah i'm i'm really surprised that it's not for profit in the sense that you know you do have these i don't look it's maybe something i need to need to brush up a little bit more on yeah um what one in your opinion is the the future of this because i mean another thing on the facebook page we had someone come and try sell a hospital plan no on the material page they came in they left oh 30 grand a month for hospital plan yeah i mean this thing was terrible in the sense that yeah you got that yeah there was actually a circular that was released recently to um for the draft um it's not called the demarcation act it's called the long-term insurance act or change anyway basically what it what it's saying is that um uh there's a there's a difference between a health insurance product and the medical scheme so the definition of the business of a medical scheme it's it's like three or four criteria and sort of like providing making provision for medical services and sort of pooling of funds and all of that and and and you get a health insurance that comes in and they do risk rating so that's the hospital cash plan now i'm talking about and it's the hospital cash plan it's the um i think those are terrible they are terrible yeah and that's what this person was trying to sell this thing to me yes because what it does is you you get sick you go to hospital and they're like here's 200 grand but i could be going in for like a little cough and there's like 50 grand or i could be going in because i've got an axe through my head and i need surgery and it's 10 000 so so the thing with the health insurance products is they're not allowed to indemnify the policy holder they cannot say we will cover your medical costs because that is the business of a medical scheme so it is now a whole thing um that they it hasn't come into um it hasn't been just dropped regulations at the moment but they're saying a whole bunch of criteria being like well a health insurance person they cannot pay the providers directly they cannot pay the hospital they have to pay you in your pocket and they cannot identify that they use it as a market we give you 500 grand as you can use on school fees on your own lunch or on anything now what happens is that you have this huge financially unsophisticated markets in africa yes these people do not understand the difference between a medical scheme and health insurance so they get a hospital cash plan and they think that they are now covered exactly that's what it's about to go and get treatment in hospital meanwhile the daily amount that are they're offering are nowhere near sufficient to stay in a private hospital and if you're going through a government hospital if your salary is low enough you're not going to be paying but even if it is high enough it's still not cheap to go in and you know go to hospital at all obviously it's not cheap so isn't this the legal fifth health insurance yes well that's what the government and the you know department of health is is concerned about because you're misleading the public you are you're actually taking away the financial the stability of the medical aid industry because what you're also doing is you have all these healthy lives here who cannot really afford the medical aid contribution because it's super cheap they even some insurance health insurance are now offering you GP visits they're offering you dental they're offering you they'll be like well here's a second mount you know you can go to the GPS unlimited times and because of PMB's medical schemes have to offer them there is a minimum cost to providing cover through medical scheme whereas a health insurer that only PMB's they can exclude old sick people they can exclude people based on whatever sort of thing anyway and they can also risk rent so they can charge you higher amounts so they have all this covered so a very healthy young person will find a especially those with families as well they'll find a package where you get GP visits unlimited GP visits like invaluable so they'll take that up they'll leave the medical scheme they'll be paying a tenth of the price at the health insurer and then you have all these people funneling in here and leaving the medical scheme industry the risk pool to deteriorate and then you have all these people here that are under the impression that they are covered when actually they're not so they they aren't covered for emergencies they aren't covered for any of the chronic diseases for cancer or anything like that so you actually have a large portion of the population going uncovered effectively when they think they are being covered doesn't mean that that's what's making up such a big chunk of your contribution is like I said cancer is very expensive so actually it's not taking up that much of a chunk of your contribution because the prevalence is so low well depends on the scheme actually so if you're talking about a discovery I don't think it's going to take up so if we're looking at the at the broad cost of how of the claims costs of the scheme you're going to get about 30 percent is going to be hospital so that's people being admitted and that's accommodation in hospital specialists everything that happens in the hospital and then you get another big chunk which is medicines which is acute medicines and chronic medicines and then you get the rest so cancer the prevalence rate and the incidence rate is quite low actually because I mean you don't there's not you don't I mean there's you know the incidence rates low in a general population in any case so it's a very severe thing there's low frequency so actually if it's covered across a huge number of people it's actually a very because what would we like to express it as is cost per life per month so basically we'll take the total claims divided by the total months that the people are in the scheme divided by the total people so then that comes down to a cost per life per month and it's actually quite small compared to your say the total gpe visits so then what what is the how are hospital plans being able to be so much cheaper than medical schemes what is what's making medical scheme so expensive for your every day buy okay so there's a number of factors for this as well so there's the pmb's which are the the base of every medical that's the prescribed minimal the described minimum benefits every scheme in South Africa has to offer these benefits and so another thing is that providers who offer these pmb the treatment and diagnosis of these of pmb's they have to the schemes have to pay them at whatever cost that they are charging them and this was because of some court case a couple of years ago so you have a scheme being charged 400 500 percent of the tariff rate and these pmb's escalating at a rate far greater than cpi then so then the the hospital plans don't have to offer these so that's just one portion okay on top of that now you have over utilization by members and i i actually had a conversation with someone who did it in applied maths degree the other day and i was trying to explain this to them and i was like um she was like no but i get those benefits they're my benefits i should be able to use them so it's like for example three gpe visits or or a physiotherapy session that you get covered by risk not from savings she'll be she said um no but they're mine i should be able to use them but there's nothing necessarily wrong with her she just has this sense that things of entitlement that but i'm paying for this that i might as well get them i must get i must get even if i'm not sick let me go to the job or even if i'm not sick let me go to the physio because my shoulders a little bit sore or whatever so now you have this weird sort of thing where the members are overclaiming because they feel entitled to benefits so then you're driving up costs because people and especially for elective things so the more complex plans so say not even more complex plans it's a pmb that they have to offer pregnancy related benefits so what happens and it happened to a a scheme now which is in big trouble one of the bigger schemes uh the biggest and so i've got the biggest closed scheme um they didn't have any uh underwriting when people join the scheme yeah so they're not allowed to hey they can but they can anyone can you can so it's like the only underwriting you can do is um waiting periods so you say okay you have this disease you're not allowed to claim for anything to do with this disease for 12 months or you can say a general waiting period of three months like pregnancy then only have a nine month so pregnancy has a waiting period usually another scheme this particular scheme didn't um have waiting periods so what would happen is people would join the scheme while they're pregnant they would cost the scheme a heck of a lot of money and then they'd leave so what you're having is you people are coming in they're contributing for say six months um they're claiming about two years worth of contributions and then they're leaving so that's driving up those costs so that's that's also so it's elective procedures which drive those up then you've got from providers so you you have all these restrictions that are placed on treatment by the schemes the scheme source and that's trying to control costs so it'll be like there's networks go to our like a doctor in the network and you won't have a copay and then they have this this agreement with the doctor so all these things are in place but then that leaves a little bit of sort of information asymmetry and it's a bit of a perverse incentive from the doctor side to try and make more money somehow so the doctors can end up pushing like supplier induced demand and it's also if you're a patient and someone and a doctor who has a medical degree says to you you need this treatment you're not necessarily going to say no no especially if it's you're not paying for it so it's a whole third party payer thing as well so if you're not paying for it a doctor tells you need this you're probably going to go and get it done so it's all these this is just and there's a lot of other factors such as the exchange rate so it comes down to if we're importing medicine and our exchange and our and the deteriorates don't we have derivatives and stuff to haste those on no don't you guys don't the medical administrators uh the medical schemes so actually the medical schemes actually have a strict investment um they're regulated for their investments they cannot invest more than four percent in derivatives i think well that's dumb yeah i know it's kind of dumb well it depends it's a short-term business you've got a lot of short-term claims most of the money that medical schemes hold on cash okay yeah so then like you said like it comes down to this currency risk yeah so it's not it's it is a risk um but it's not the main thing i would say that's driving the contribution increases and then of course you've got the healthier lives leaving and you've got all the sicker lives staying and that just right then you don't have the cross-subsidization from the healthy to the sick and then you have this misterial death this put me off health because not only do i get very squeamish when i hear blood dead no cardio bypass surgery and all that that stuff you know makes me dizzy but looking at all of this it kind of feels like it's a bit of a sinking shock you know and it's something that also got the same impression when it came to to pensions you know people are living longer and they're tiring earlier and and all these type of things so it i guess it's good news for us because i mean we're gonna have a job you know and exactly and you know so these people society will still need us but it's almost as if we've created these problems or our you know the last generation of actuaries created these problems because yeah it it sounds all good in theory but then when you look at people joining in claiming jumping out or you know these hospital insurance things popping up here and all these other things coming up it does y'all it does very much sound like a like a sinking ship so i think we're doing quite well for time oh my gosh we've been talking for 44 minutes okay so let's maybe just end with one very quick question and that is where do you see the future of south africa from a medical point of view in say 10 years time is it going to be good have we in the future do we solve all the problems and everybody's happy or do we stuff up and south africa goes down in flames and we all get sick and we get wiped out by like the black plate or something like that what what is your forecast on south africa's medical uh state in 10 years time so that is a very difficult question to answer because five seconds to answer it no so it's just like this nhi is the deterioration of the medical scheme industry there is um our shortage of doctors especially in the public sector there is the severe financial inequality we're the most unequal society in the world um so how do you how do you take how do you take a private the private sector and apply it to the entire country which is basically what we're dealing with now because the public sector is in jambles it cannot we cannot rely on the public sector to provide healthcare for the entire country it is just not feasible so in 10 years time do we the future actuaries like us figure out all these problems and make it all better or does this ship continue to sink until it's no longer saleable i guess that depends on the political party that's ruling but in your your opinion are we going to is it good or is it bad i'm going to stay optimistic and say it's good okay fantastic and i think you're this may be ended up there because you're just 46 minutes now gosh this has been uh i'm going to say a conclusion yo let's well yeah i i don't know if people are still probably going to be listening to you're gonna have to edit it so you could you could edit this into two parts and just chuck out cut out all the rest so i'm going to say goodbye do you want to say goodbye or yeah i do want to say goodbye or do you want to say thank you or i don't know what do people say let's just go with the classic hey guys thanks for watching hit like subscribe see you next time bye