Unions, insurers warn govt on health insurance

The National Health Insurance Scheme (NHIS) passed by Cabinet on Monday and billed as a silver bullet in providing universal healthcare will face major hurdles in enforcement, workers unions and insurers have warned.
Speaking to Daily Monitor in an interview on Wednesday, the National Organisation of Trade Unions (NOTU) chairperson, Mr Wilson Owere, warned of likely troubles in determining the contribution of money to the health scheme.
He also cited problems of collection of contributions from the informal sector, saying many groups have received no support from government to get organised.
“We brought some informal sector groups under Amalgamated Transport and General Workers’ Union (ATGWU), but we encountered many challenges in bringing them together,” Mr Owere said.
The NHIS Bill proposes that government will deduct 4 per cent from employees monthly salary while one per cent will be contributed by the employers.
The Bill also says self-employed people will contribute Shs100,000 annually to the NHIS while pensioners will contribute one per cent from their monthly pay.
The scheme exempts those deemed living below the poverty line.
Mr Owere said government wants to shift the burden of contributing revenue for NHIS to the salaried workers, who are already heavily taxed.
“The methods proposed by Ministry of Health to collect contributions for NHIS are not any different from those Local Government instituted to collect Local Service Taxes. But since enforcement of the Local Service Taxes, only salaried workers are paying since the deductions are made on their salaries,” Mr Owere added.
Mr Timothy Mabirizi, an insurance consultant, said health insurance is one of the most expensive products and Shs100,000 as an insurance premium is too low for one to secure quality healthcare.
“The profitability of this insurance scheme will be very difficult. You have heard that some hospitals are asking for a deposit of Shs3m just on patient admission. The average premium you can get for reasonable health insurance is Shs1m,” Mr Mabirizi said.
Mr Mabirizi said with the stated contributions against the demands, the total revenues may not sustain the scheme.
Health ministry spokesperson Emmanuel Ainebyoona said the NHIS Bill when passed by Parliament will be implemented in a phased manner, starting with the salaried employees, then the self-employed through their community savings associations.
“The government will be required to carry out an annual assessment to establish those who are below the poverty line to be able to access the scheme for free,” Mr Ainebyoona said.

Sector control

Data from Uganda Bureau of Statistics (UBoS) statistical abstract of 2018, indicate that the informal sector controls more than 60 per cent of the economy while only 20 per cent is in formal sector.
Workers unions, including ATGWU, have often fought government agencies implementing laws that seek to impose more charges on their members. ATGWU comprises motorcyclists, taxi and lorry operators.