First, Asher and Nandy argue that the financing system is inefficient because it has limited risk-pooling features, such as mandatory health insurance or broad government subsidies, which are widely regarded as efficient as they address adverse selection and other market failures. 20 As previously discussed, MediShield is not an extensive risk-pooling arrangement when measured against the universal health insurance of other developed economies. This is because MediShield operates very much like private insurance and is run on commercial, rather than social, principles. As noted, to prevent cross-subsidisation, premiums are not pooled across age groups. MediShield also excludes both high-risk individuals (the elderly