Country’s sick health system in need of affordable health insurance

 

By NICHOLAS KALUNGI

Uganda risks lagging behind in the region should it delay to incorporate health insurance in the social security package offered by National Social Secuity Fund (NSSF). Using different income related benefit schemes, NSSF could alleviate the plight of most Ugandans, especially the low income earners who can not afford basic treatment due to high costs.

At the fourth East and Central Africa Social Security Association (ECASSA) conference held in Kampala, several issues were discussed with Health care insurance among the lead topics. Delegates who attended the conference recommended that public and private pension schemes should include the component of health care insurance in their social security policies.

Among the other resolutions, the delegates advised governments to support and encourage the extension of health insurance through social security to the private and informal sector such that majority of the citizens are covered.

No national health insurance policy
All member states of ECASSA have the component of health care insurance in their packages for their clientele except Uganda. NSFF does not provide this service even when the importance of health care insurance is appreciated and well known even in here.

But even social security which encompasses health is a fundamental human right. International human right documents like the universal declaration of human rights of 1948, International Covenant on Economic, Social and Cultural Rights of 1966, and the ILO Social Security (Minimum Standards) Convention all communicate social security that includes health as a human right in their respective articles.

While presenting a paper on Liberalization and Reforms of Social Security in the East African community recently, Dr John Jean Barya, an associate Law Professor at Makerere University said that Uganda needs to work on providing health care insurance in the social security sector packages as health care is an important benefit under International Labour Organisation (ILO) Convention of social security systems.

“This is a major element of social security and must be dealt with in any social security system. The medical insurance schemes need to aspire to universal (100% of the population) coverage. Experiences of Rwanda, Kenya and Ghana could be instructive for the other Uganda and other East African countries,” Dr Barya said.

He added: “The East African private healthcare system that was intended to give free access to health care to the whole population is generally dysfunctional. However Rwanda and Kenya have moved to provide for potentially universal coverage through universal health insurance structures.”

Globalstandards
The ILO Convention No.102, the Social Security (Minimum Standards) Convention No.102 of 1952, the right to social security should cover nine core elements that include health care, old age, sickness benefits, and disability benefits among others.

However, according to the managing director of Muhanna Group, an Actuarial Consulting Firm, Mr Ibrahim Muhanna, the adoption and success of a social security policy on health thrives on a solidarity principle, where the health cross subsidize the sick, the rich subsidize the poor.”

“In the first place, employees receive different wages, and with the rise in capitalism, some people may not agree to help in carrying others’ health cross. Therefore, people who earn little wages will not be able to reach the premium rates per annum rendering the policy unattainable,” Muhanna said.

He added; “For instance if the premium is at Shs350000 and the contributions towards health is five percent per month, that person would have collected Shs300000 by the end of the year which is less than the premium. On the contrary, people who earn more will feel cheated to share the same health package as the low income earners.”

Mr Muhanna argues that most of the covered members would prefer private medical providers who charge relatively higher prices than Government facilities. “Although public health units are well equipped, there are people who will feel inconvenienced to go to a public hospital which cites a problem in the implementation of the policy.”

Elsewhere in the region
Ms Angelique Kantengwa, the current managing director of Rwanda Social Security Board (RSSB) one of the recommendable health care insurance providers in the region shares the same sentiments. In a recent interview, she told Prosper magazine that the expansion of health care coverage in Rwanda has been as a result of harmony and the positive attitude between the stakeholders involved.

“In my country, we are already providing Health insurance as a core component of social security and our results are good. It all goes back to the commitment of all stakeholders. If employees agree to have this service and then the organization in charge finds out how to offer it in the best cost effective way, then why not?” Kantengwa questioned, adding;
 

“Health care insurance in this sector will only prosper where there is cohesion and willingness between contributors no matter their health conditions or wealth levels. The financial cost for providing this service is huge and that is why there should be country solidarity.”

Meanwhile, Mr Muhanna pointed out that the financial cost for a health care insurance policy is varying.
“It basically depends on the benefit packages like in-patient, out-patient, chronic illnesses, number of exclusions, number of dependants covered per contributing member as well as demographic factors like morbidity/rate at which people fall sick,” he said.

He added; “Since these keep changing, there will be no way this scheme can be valued. It is proposed that it can be revised usually after three years and the scheme must keep a reasonable level of reserves to cater for any eventualities.”

He however believes that the cost of healthcare for the elderly could be a fiscal time bomb for governments if its financing is not addressed appropriately.

Impact
Responding to the significance of health care insurance, Mr Richard Byarugaba, the managing director National Social Security Fund (NSSF) said that its need is known but cannot be adapted immediately as it involves a longer procedure.

“Our neighbours have already adapted this which again shows that we are still a step backward. Health Care Insurance is an important benefit though needs more study and analysis before it is implemented,” Mr Byarugaba said.

“We should be able to have this package for the Fund’s contributors. But as you know, it is a big project that is not only dependant to our will but also the government and other stakeholders.” The inclusion of the health care insurance benefit on Uganda’s Social Security Scheme will among others help employees to receive quality health services anytime. Unlike the pension scheme that requires someone to reach a particular age before they can receive their funds, health care insurance has no age limitations.