Ms Robinah Nabbanja, the State minister for Health in Charge of General Duties, on Wednesday informed the Parliament’s committee on Health that the national insurance Bill, which provides for universal health care, is on hold. She said the President raised some concerns and called for further consultations about the scheme and raised specified concerns about how the scheme will be financed.
In particular, the President wanted a clear direction on how the health service for the poor who cannot pay the premiums will be financed.
Whereas we understand the dire need for health services provision in this country, and are acutely aware of the need for a financing model that will increase accessibility to treatment, we have in the past raised issues about the proposed Bill. We are pleased that the President and other officials are paying heed to them.
One important flaw of the proposed Bill is the attempt to impose another tax on the small working class in a bid to finance health service provision to everyone. The Bill as proposed provides for a monthly contribution by salary earners and caps the contribution of non-salaried Ugandans at Shs100,000 a year. Ugandans who are deemed to be too poor to afford the premium would be enrolled onto the scheme and pay nothing.
The contribution off one’s salary would be blind to whether they are already enrolled onto a health service scheme, meaning that the existing medical insurance providers would be thrown into jeopardy since the companies which currently contribute for their employees will likely withdraw and ask their employees to enrol to the national scheme.
There are genuine fears about how well a scheme that will be too big as to enrol everyone would be managed. And in the end would there be enough money to pay for everyone’s treatment in the scheme?
The alternative seems simple. The government should encourage private service providers to develop packages that enrol more Ugandans – farmers, those in the informal sector etc. The citizens would have more choice as to which service provider to subscribe to, which will guarantee better services. The government just needs to ensure strict supervision of the providers.
Then for the Ugandans who are too poor to afford the premiums, the government should register them and a funding model for their premiums be developed. Could it be by getting every taxpayer to pay a percentage point more?