National Health Insurance Scheme(NHIS)
The activities of UHF over the last five years have increased in scope to include health sector program implementation, development of human resources in health, promotion of innovation in health while actively lobbying for a Uganda National Health Insurance Scheme (NHIS) and rising awareness for Community Based Health Insurance Schemes. Recent legislation and regulations directly addressed structural and operational elements of the HMO and Health Insurance Organisations (HIO) fraternity, resulting in a drop from eleven to seven registered and licensed HMOs in 2016.
The science behind the 36% decline is yet to be proven as newly established HMOs as well as long-standing HMOs alike bowed out of a sector of insurance that bumped penetration up by 0.2%, by simply being counted. Regulation of HMOs in neighbouring Kenya simply forced HMOs to transform into insurers or brokers, while in Uganda, the HMOs businesses that opted not to renew their licenses as HMOs, shed off the costly arm of insurance and continue to provide health services through their facilities for walk-ins and as health insurance service providers. Undoubtedly appreciating the simpler life of not having to tussle with perpetually problematic providers’ upcountry with fraudulent claims or polypharmacy amongst other issues.
Universal health coverage through a national health insurance scheme in Uganda would do well to observe the experiences and learning from HMOs. Especially as their structure would be a hybrid of the HMO model. The government would be the insurer, with some owned facilities (the government facilities) and a network of preferred providers. Consumers will undoubtedly behave the same; prefer to go outside of the network of public facilities where claims do tend to cost more, due to variances in operational dynamics and few concessions. Ideally, the new NHIS scheme would be mandatory and would as HMOs do, have to compete with the health insurance companies and community-based health schemes, each of which has a unique appeal intrinsic in their structure, pricing, and scope.
Even with economic dynamics considered Uganda’s out of pocket expenditure on health is high at 53%, while Rwanda which has a government-owned health insurance scheme called RAMA managed by their social security parastatal (RSSB) stands at 18%.
The private health stakeholders including Uganda Healthcare Federation, together with the Private Sector Foundation Uganda (PSFU), Federation of Uganda Employers (FUE) and Uganda Insurers Association (UIA) have systematically lobbied and advocated for some adjustments to the proposed NHIS highlighting several key considerations to the proposed NHIS bill.
The recommendations by this bloc proposed legislation mandate all employers to provide medical insurance alleviating the burden on government resources.
Additionally, the basic health package is stipulated following an actuarial study and reconsideration of increasing the tax burden on employee salaries to cater for NHIS. Finally, existing health insurance companies should be inculcated intimately into the planned structures due to their experience and understanding of the consumption of health insurance in Uganda, which remains unique. It is suggested that the scheme considers administration through the National Social Security Fund, not only due to their compliance increases but because of their established collection mechanisms. There continue to be deliberations of the exact format of the phased approach to be adopted, however, it is agreed implementation has to be phased.
UHF goes further to consider a supplementary proposal for an NHIS roll out using a phased approach which includes children aged 13 and below, adults aged over 70 and persons with disabilities, through a basic healthcare package. While these segments of society aren’t able to contribute to the financial basket, it is prudent to consider that the bulk of healthcare spending both out of pocket and by the government is in these two categories. There needs to be further dialogue on the benefits and implications contributions by the entire population to build a fund, to provide health to these vulnerable groups. This phased approach scaling up over a period of 15 years would gradually increase the age ranges covered as well as the scope of cover, at a pace that is financially sustainable. Discussions on the various dynamics of the financing of a sustainable NHIS system are on-going and the conclusive position will likely determine the scope of cover that can be given.
While health insurance in Uganda trudges along the trail to National Health Insurance, current provider pillars namely HMOs, health insurers and community-based health schemes all have a valuable contribution to make a viable and sustainable National Health Insurance Scheme. Experiences from each pillar in product design, claims experience and premium calculations provide a mass pilot, with invaluable data that would be a travesty to not be utilized.
The following are different findings carried out by Management Sciences for Health (MSH) in Rwanda about Community-Based Health Insurance, its experiences and Lessons, its impact on Access to Care and Equity in Rwanda and technical briefs of each.
The Insurance Complaints Bureau Guidelines 2017
Objective Of the Guideline:
The objective of the these guidelines is to provide for an effective complaint handling system to the Authority which;
(a) resolves issues raised by members of the public against an insurance player in a timely and cost effective way;
(b) may provide information that may lead to improvements in insurance service delivery; and
(c) improve the reputation of the Authority and strengthen the public confidence in insurance.