How government health insurance will work

Kampala. Cabinet on Monday approved the National Health Insurance Scheme (NHIS) 2019 that will require all Ugandans above 18 years to contribute to the scheme before accessing health services across the country.

Ms Sarah Byakisa, the commissioner for policy, finance, and planning with Ministry of Health, told journalists at Uganda Media Centre in Kampala yesterday that the scheme is a must-pay-for by all Ugandans and foreigners in the country.

“Every contributor shall upon payment of the prescribed contribution, be issued with a card for purposes of identification and verification to access healthcare benefits under the scheme,” she said.

However, underprivileged people such as the poor who can hardly earn $1.5 (about Shs5,462.95) a day, people with disability (PWDS), the elderly, orphans, and street children will not pay any fee, but will get insurance cards from the government to access health services.

“They will be determined using an agreed upon criteria that will focus on the socio-economic status of individuals who will be mapped within their areas of residence using standard tools for collecting information about their socio-economic status,” Ms Byakisa said.

“A board of members shall be formed after the law has been enacted by Parliament, which will accredit, regulate, monitor and supervise healthcare providers,” she added.
Government hospitals and accredited private health providers that meet the set standards shall offer the services to patients.
Ms Byakisa did not specify what standards would be used to choose the private health service providers.

Mode of payment
Ms Byakika said employees in the formal sector will be subjected to 4 per cent deductions from their salaries while their employers will contribute 1 per cent to the health scheme.
She said individuals in the informal sector will pay a proposed Shs100,000 annually.

“A person whose income is derived from salaried employment, a monthly deduction from the wage will be done by the employers, and those whose income is derived from self-employment will make an annual contribution in the manner and the rate that may be prescribed in the regulations,” Ms Byakika said.

When consulted on how the government will trace individuals in the informal sector who are scattered across the country, Ms Byakika said they will consider organised communities, especially those in different associations, who will be required to pay they contribution through their respective groups into the scheme.
She said those who are not in any associations will be followed up by local government heads and local councils at the grassroots.

Dropping private insurance
Ms Byakika said individuals who are currently subscribing to private insurance companies will have to drop that scheme and enrol for the government scheme.
“Once the law has been enacted, all Ugandans will be required to contribute to the government scheme. The private insurers had failed to take off, since they were covering only few individuals in the formal sector, totalling about 2 per cent, so they had failed to provide health services to all Ugandans,” Ms Byakika said.

But she said the new NHIS will collaborate with private health insurers to provide supplementary packages for services not covered under the government scheme.
Ms Byakika said government will only be able to offer a national minimum healthcare package for common diseases such as malaria, diabetes, and hypertension.

She said: “Patients who need specialised care like organ transplant, plastic surgery, danger fixtures and artificial fertilisation will not be catered for under the package the government is going to offer.”
Ms Byakika said private commercial insurers can take advantage of that gap.

Penalties
Government also warns that Individuals who will not possess the insurance card will not access health services since they are going to phase out free medication in all their hospitals, once the Bill is enacted.

“Government will stop providing free health services in all our government hospitals. Ugandans without the insurance cards will only be able to access immunisation, which has been maintained for free,” Ms Byakika warned.
She said individuals with emergencies, including those who will be involved in accidents, will be able to access free services even without the health insurance card.

Beneficiaries
Ms Byakika said for every contributor, a spouse and children below 18 years will access the defined benefits packages irrespective of the amount of contribution.
But she said should both wife and her husband be working in the formal sector, both will have to pay for the health insurance scheme.

She noted that any Ugandan above the age of 18 years without income of his or her own, a person with a disability who is wholly dependent on someone and students who are undergoing a full-time course of education will benefit on the contributors they are staying with.

Government spokesperson Ofwono Opondo said the Bill is set to be tabled before Parliament for discussion in two or three months.
He said once enacted, it will be the role of government to provide quality health services in all government hospitals to ensure value for money.

Background
2006 Draft Bill
In his draft Bill on the proposed National Health Insurance Scheme, Dr Francis Runumi from the Ministry of Health, then said the scheme, which he had hoped would have started last month, “seeks to ensure that Ugandans have financial access to affordable, equitable and quality healthcare services progressively to all residents in an efficient manner through health insurance.”

Opposition to scheme
In 2006, the government announced plans to introduce a National Health Insurance Scheme where all Ugandan residents would be required to have a health insurance policy. But the scheme faced stiff criticism from major stakeholders, who described it as another burden to employees, expressing fears that such a policy might increase the already high cost of doing business in the country. In July 2017, the Ministry of Finance awarded a Certificate of Financial Implication for the National Health Insurance Bill, paving way for the creation of the scheme. The NHIS is expected to relieve ordinary Ugandans from directly pulling money out of their pockets to spend on medical bills.

Drafted nearly 13 years ago, the Health Insurance Bill, according to Health minister Jane Ruth Aceng will initially see about 25 per cent of the 34 million Ugandans covered once it is enacted into law.
Many health activists have been pressuring the government to have the Bill enacted to save Ugandans from the hustle of accessing health services out of pocket.

Reactions

Prof Francis Omaswa, the executive director of African Centre for Global Health and Social Transformation, said: “We have been waiting for years, Kenya has got one and Tanzania too. Let’s wait, it can be amended then we can comment on what can be in the Bill. Anybody who needs medical services should not be expected to pay at the time when they are sick, how we do that we need to agree. We can even be innovative, for example, paying with what you have, it can be [charged on] bunches of matooke, milk, etc.”

Mr Ibrahim Kaddunabbi, the executive director of Insurance Regulatory Authority, welcomed the idea but called upon the Government to involve technical people when making the decisions. “It is very important for each Ugandan to have health insurance. Who will contribute and the how to operate we can look and guide. What to contribute should be arrived at with the input of technical people or else you are bound to make mistakes,” he said.

Dr Kezekia Tumwebaze, a medical doctor at Healthy Nation Hospital, said: “It is very much welcome. People are unable to pay in private hospitals because they are poor, government is unable to give free services, and free services are practically impossible. So the health insurance scheme is the answer. The insurance that has been going on is for the rich and those who have been suffering are the low income earners.”

Mr Frank Mwesigye, a mechanic, said: “I have no idea what that (national health insurance scheme) is all about, probably government needs to educate us.”

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