The burden of not being medically insured: testimonies

It has been just two weeks since Francis Lucas, 66, was left unattended at the government hospital in Kigoma. He showed up at the hospital under the impression that his treatment will be done for free, assuming that the government recognised and authorised free treatment for old people [senior citizens].

Your Health caught up with Francis at the Muhimbili National Hospital (MNH), where he reveals that life without health insurance is never easy, especially for people at his age.

“The older persons are the most affected among all the age groups as they don’t have access to money most of the times,” Francis tells.

When priorities change at the hospital

With the increasing cost of treatment, life has never been the same for people like Francis who cannot afford to pay for their treatment.

Upon further narrating his story back in Kigoma, Francis says, that day he had remained seated waiting for more than five hours in front of the consultation room titled ‘older persons’ at the hospital.

“In that span of time, I neither saw a doctor nor a nurse enter that room.”

But what surprised Francis was the room next to the empty room he had been staring at, titled ‘health insurance’, which had a constant flow of patients coming in and out.

According to Francis, the health insurance room was very busy and had a divsion of two other rooms in it. So, two doctors would attend patients without any obstacle.

Upon asking why the other room was busy, one of the sweepers at the hospital said, ‘these people are insured. They have health insurance cards. It makes it easy for them to be treated.’

“I had fever and I was in pain. None of the nurses paid attention to me. I tried to ask as many times as I could what the procedures were to be followed to be treated for free as an older person, but none of the nurses had a clear answer. They kept on telling me to wait for the doctor,” Francis recalls.

It was until then the kind sweeper whispered to him that ‘the room is never used, it is just there but not functional.’

He says that he only had Sh2000 in his pocket and he expected to use that money for his transport back home.

Seven hours later there was still no sign of response and Francis then decided to walk out of the hospital. On his way home he received money from his son who lives in Dar es Salaam and planned to go back to the hospital the following day.

However, on the same night he was in a critical condition and was taken to the hospital where he was admitted for two days without a sign of improvement. His son flew him to Dar es Salaam for further treatment and he is currently responding positively to treatment at MNH.

Burden of health-care costs without an insurance card

Majority prefer health insurance schemes that keep them safe when they fall sick at the time they don’t have money to pay for their bills.

However, for a country with a population of more than 50 million, only people in formal employment enjoy the health insurance schemes.

Experts say that getting hurt or sick isn’t something a person aspires, but unexpected medical events do occur. Having a health insurance plan helps pay for some of those unexpected costs, and provides financial protection against ongoing large medical bills.

Such a case of an unexpected event was experienced by 33-year-old Mariamu Hamis, a mother of two children.

Sharing her story with Your Health, she says that, two years ago her employer used to cover her health insurance, which covered her husband and two children. She was also contributing about seven per cent of her salary towards treatment.

“My life was insured by julibee insurance. Life was very easy. Things changed when the company terminated my permanent employment contract which scrapped me off from health insurance. I pray every day that none of my family members would need to be treated for more thanSh100,000,” says Mariamu.

She further says that her husband is not in formal employment so it is never easy to monitor his income, this makes it hard for the family to make effort in raising extra money that will support treatment upon unexpected medical events.

Mariamu thanks the Almighty upon recalling the incident when one of her child was operated at the Regency hospital where the surgery cost them more than Sh1,000,000. But then her insurance was till intact.

Her maternal clinics and delivery of both of her children had costed Sh2,250,000, which was also covered by the insurance then.

“I thank the Almighty that the demotion came at the time I had given birth using my insurance. If it were not the insurance I think we would only end up with one child. I can feel the pressure of living with no health insurance,” says Mariamu.

Another similar case was narrated by Anitha James (not her real name), married with three children. For the past three months, her househelp has been going through a series of pain, upon which the medical examinations revealed she has fibroids.

The resident of Dar es Salaam grieves to Your Health that, her househelp is not medically insured. It makes it hard for her to get treated as soon as possible in the government hospitals due to bureaucracy. And with private hospital, it is very expensive for Anitha’s family to afford surgery.

“Her surgery at the private hospital costs more than Sh1,000,000. My family cannot afford this in the meantime. She has to wait for her treatment at the public hospital, though I don’t know how long the process will take,” says Anitha.

Adding to that she says, both Anitha and her househlep think it could have been much easier with the health insurance.

How does the health insurance work?

Gabriel Ishole, Human Resources Manager at the National Health Insurance Fund (NHIF), explains to Your Health that in order for an employee to enrol in an insurance scheme, the relationship between employee and employer matters.

The employee contributes 3 per cent of his/her salary while the employer also contributes 3 per cent to treatment, this makes a total of 6 per cent per year. For individuals, one has to pay Sh1,501,200 in a year.

Adding to that he says, for children under 18 years of age, they contribute up to Sh50,400 per year, same fee also caters for students from registered institutions and schools.

There is also a way of paying as a group which cost up to Sh76,800 per year. The grouop must consist of at least 30 people, with the aim of supporting one another financially.

In the recent parliament budget seating, The Citizen quoted Members of Parliament (MPs) who demanded an explanation from the health minister on why at least 23 public entities had not joined the National Health Insurance Fund against a government directive to have all state-run institutions covered by the public health insurer.

The topic was brought up by Mr Mlinga (Ulanga-CCM), who wanted to know how many public entities have so far joined the national health insurance shceme since its establishment, and how many were yet to join and why.

Also Babati Urban MP Paulina Gekul (Chadema) wanted to know what steps the government was taking to set friendly procedures for ensuring local hospitals are equally benefiting from diverse loans from NHIF.

Health, Community Development, Gender, Elderly and Children minister, Ummy Mwalimu, said that it was mandatory for all public entity to join with NHIF.

“Recently, I held a round-table meeting with the ministry of finance to discuss this, and ensure all public entities that had not joined NHIF immediately do so. But it was revealed that most of them had long-term contracts with private health insurers; so we are working on ways to professionally terminate the contracts,” the minister reverted.

By March this year, NHIF had a total of 792,987 active members from at least 474,760 members in 2012, according to the minister. A total of 307 public entities and departments are members of NHIF.

Under NHIF there has been a steady increase in coverage from 2 per cent of the total population in 2001/2002 to 7.1 in 2011.

Other forms of insurance like Community Health Fund (CHF), Social Health Insurance Benefit (SHIB) under National Social Security Fund (NSSF), Tiba Kwa Kadi (Tika) and private insurance schemes cover more or less the same percentage of the population as NHIF.

It means, only 10 million Tanzanians are covered by health insurance of one kind or other. This is just 20 percent of the population as the remaining are left out.