Health insurance bill is good tidings

By Francis Runumi

Parliament on March 29 presented for the second reading the long-awaited National Health Insurance Bill, which was earlier tabled by the Minister of Health.

Special thanks go to the ministers of health, Dr Michael Bukenya, the chairperson of of the health committee and his entire team for the background work and struggles they went through to reach this stage.

A well-intentioned, researched and widely consulted Bill to enable the entire population access equitable good health care deserves support.

The last political campaigns were hard for many candidates. One of the sticking issues the electorate decried was poor healthcare, especially for mothers and children across most public outlets.

Whereas the Government, with all good intentions, promises good health services as spelt out in the 1995 Constitution Objective XX, quote: “The State shall take all practical measures to ensure the provision of

basic medical services to the population”, available resources remain inadequate for the soaring demand.

The demand and supply of health goods have remained divergent for long. The National Health Insurance Bill in question is a result of research, consultations and benchmarking since1987 through technical and political discourse.

All efforts base on the social security concept, a foundation adopted by the International Labour Organisation (ILO) in 1944. Social security is

important for the well-being of workers, their families and the entire community. It is a basic human right and a fundamental means for creating social cohesion.

It is also an indispensable part of government social policy and an important tool to prevent poverty. It can, through national solidarity and fair burden sharing, contribute to human dignity, equity and social justice.

It is also important for political inclusion, empowerment and the development of democracy. In simple terms, here, everyone will contribute according to their abilities and all of us shall receive health benefits according to need.

Therefore, the National Health Insurance Scheme as a form of social security, once properly managed, will enhance productivity by providing healthcare services equitably.

In conjunction with a growing economy and active labour market policies, it is an instrument for sustainable social and economic development once the population keeps healthy.

While social security is a cost for enterprises, it is also an investment in, or support for people.

With globalisation and structural adjustment policies, social security has become more necessary than ever.

In concurrence with the above observations, Cabinet directed the Ministry of Health, under minute CT 63 (CT – 2006), to provide stewardship and issue drafting instructions to the 1st Parliamentary Counsel.

Thereafter, stakeholders formed a National Health Insurance steering committee comprising trade unionists, Government ministries, insurers, employers, manufacturers, frst parliamentary counsel, among others.

The World Health Organisation (WHO), World Bank and ILO gave significant technical inputs in the design process. A countrywide interative consultative approach to sensitisation and garner public support on the scheme was adopted and executed between 2007 and 2010.

In addition, benchmarking with successful countries that had similar insurance arrangements was done, notably with Thailand and Vietnam, among others.

The Germany sickness funds system was studied and young African schemes were also visited to pick the good practices and challenges faced, notably India, Rwanda and Kenya, among others. Further consultations and refinement of the design continued up to 2020, when the Bill was finally tabled in Parliament.

The paucity of resources for health still glares. Using data from the recent National Health Accounts of the Ministry of Health, 2016/17 -2018/19, it is evident the sector is grossly underfunded and there is no way we can expect better services without mobilising more funding from new sources. Increase in government health budget is imperative, whatever challenges the national purse is facing.

HOW MUCH SPENT

Money spent on health from all sources was sh4.7 trillion in 2016/17; sh5.25 trillion in 2017/18 and sh5.5 trillion in 2018/19. This translates to sh127,000 ($34) per head in 2016/17; sh136,000 ($36.7); and sh138,000 ($ 37) per Ugandan.

WHO recommends spending at least $84 per head annually in order to access basic health care as a way to achieve Universal Health Coverage by 2030.

The funding gap continues to grow as a result of population growth without commensurate expenditure.

But how is this money contributed? Three main categories of contributors exist.

The Government contributes about 17.2%; private sector 41.4% and donors, also regarded as development partners 41.4% (FY 2018/2019). Of the 41.4% expenditure by the private sector, 37.7% is from out-of-pocket expenditure.

This is more than double what government spends on health and partly explains the nature of services we see.

There is need, therefore, to increase spending, especially from Government and the private sector to prevent a bad situation from getting worse. The National Health Insurance Bill aims to boost and streamline contributions in a broader, structured and organised way.

COVID-19 EFFECT

In the current COVID-19 pandemic, people have had to part with hospital bills, ranging from sh0.2-sh4.7m daily while admitted in the intensive care unit.

No patient was prepared for such unpredictable situations. Property, in some instances, is sold to settle such bills, driving people into poverty.

Medical insurance in Uganda stands at 1%, while our neighbours have progressively increased medical cover for their citizens, with Kenya standing at 42%, Tanzania 33%, Burundi 24% and Rwanda at 91%.

Overseas, European countries stand at 100%, while Asian countries fall between 40 – 90% coverage.

It is in Africa where we still face heavy out-ofpocket(OOP) expenditure.

The World Bank recently noted a rise in OOP from 40% in 2010 to 60% in 2014.

WHO has warned that any OOP expenditure above 15% is catastrophic and drives the population into poverty, misery and death.

In conclusion, the National Health Insurance scheme endeavours to observe the health rights of the population by enabling equitable access to quality and affordable health care at the time of need.

Details should come out once the health ministry is poised to roll out the scheme.

The design process captured many positive developments, especially in sub-Saharan Africa, where health systems have reformed in health financing, human resource management, restructuring and public private sector integration, among others.

The downside was mostly information asymmetry, leading to uninformed resistance towards making contributions, mostly by private sector investors.

Moving forward, mass sensitisation on this novel scheme is paramount. The discomfort of the formal sector employers and employees is a misconception that contributions will dig too deep into their coffers. This is unlikely. Numbers have to be crunched case by case to prove the claims.

Many corporate entities, manufacturers and other private sector entities have already instituted hospitals or clinics at their premises or contracted outside providers to treat and manage their workers. It is in appreciation of the workers’ health rights, but also the understanding that only a healthy workforce can be productive to realise set corporate objectives.

The writer is a public health physician in Kabale and previously part of the team that developed the National Health Insurance Bill