Why clarity is needed for health insurance

Monday August 15 2022
Insurance

Health insurance can be embraced, if well understood. PHOTO | COURTESY

By Lucy Tomeka
By Hellen Nachilongo

We recently read of 22-year-old, Lightness Shirima and the ordeal she endured at the hands of the Muhimbili Mloganzila Hospital when they declined to return her national identification card after she explained that she was unable to settle her late father’s hospital bill which stood at a whooping Sh9 million.

When the media brought to light her ordeal, the Minister of Health, Ms Ummy Mwalimu acted swiftly to ensure a gross injustice isn’t carried out on a helpless citizen.

Read: Why Tanzania should invest in universal health insurance

Lightness isn’t alone in her struggle to clear medical bills. Another local resident of Mwananyamala, Mr Ezekia Mmari explains how hopeful he was when he applied for a National Health Insurance Fund (NHIF) cover and that he and his children would receive better medical care with the cover.

However, his hopes were crushed when one of his sons was hospitalised and doctors still demanded cash payment for his treatment.

“I remember in 2020, my 13-year-old boy was hospitalised at a certain referral hospital for a hand surgery but to my surprise, the doctors that requested the surgery instead asked for money. I had to pay over Sh800, 000 for them to perform the surgery. After that incident, I have never tried to renew the NHIF services,” said Mmari.

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In another scenario, Your Health had a chat with a boda boda rider named Mr Jumna Athuman to know if has registered for any insurance services.

“I have heard about health insurance covers, but I have not taken time to learn more about them and how they work. I cannot talk much on the subject because am not all that informed,” he said.

Understanding and embracing of medical insurance services among the many regular citizens is still a work in progress.

Read: Why universal health insurance coverage Bill has been delayed

However, a study conducted by the President’s Office, Regional Administration and Local government (PORALG) in collaboration with the Health Promotion and System Strengthening (HPSS) Project with funds from Swiss government also indicates that a majority of Tanzanians know about health coverage.

When made aware of Lightness’ situation, the health minister then took to her Instagram to request both Lightness’ contacts as well as explain that the government was working towards enacting a Universal Health Insurance scheme.

In another separate event, the Annual Scientific Conference held sometime in early June of this year, the minister also revealed that studies indicated that 73 percent of Tanzanians would be comfortable going for the service.

“A study conducted by the National Institute for Medical Research (NIMR) revealed that 73 percent of Tanzanians who were involved in the study expressed their willingness to contribute to the universal health insurance fund,” she said.

The country has already pledged to ensure that all households are covered by the Universal Health Coverage (UHC) and that they access quality health services to help reduce child and maternal mortality rates, amongst other issues.

However, most of the families that are covered by health insurance face challenges when seeking medical treatment because some of the medication are not covered by the insurance.

Read: Government sets aside Sh149 billion for universal health coverage

In addition to the UHC, Tanzania also rolled out the improved Community Health Funds (iCHF) in 2018, largely to benefit those in rural and remote communities.

The improved CHF program aimed at strengthening CHF structures and procedures to vastly improve the benefit package of the CHF and to increase enrolment into the scheme.

CHFs are voluntary community-based prepayment schemes, which aim at building a sustainable financing mechanism for health care.

Also at the Annual Scientific Conference, the PORALG Director of Health, Social Welfare and Nutrition Services; Dr Ntuli Kapologwe explained that it is important to continue providing awareness and motivation for active members to continue renewing membership.

He stressed that despite having three million members registered with iCHF majority of respondents do not know iCHF benefit packages while those from the richest regions considered iCHF as insurance for the poor.

The key reasons for not joining iCHF is shortage of drugs at health facilities and health providers not valuing iCHF members.

“Availability of health facilities is also strongly associated with the decision to join [or not] the cover,” he added.

“Acting on the necessity of the current iCHF scheme to increase enrolments and availability of medication at health facilities needs to be improved while promoting and marketing iCHF benefit packages is equally as crucial to ensure increased enrolments.”

According to him, each Tanzanian is capable of contributing between Sh60, 000 to Sh65, 000 per year for the cover and in return, be able to access health services at all major facilities in the country, including the Muhimbili National Hospital and Bugando Zonal Referral Hospital among others.

However, the existing situation still leaves a lot to be desired.

Data produced in Parliament by Ms Mwalimu showed that until December 2021, it was only a total of about 9 million Tanzanians, representing roughly 15 percent of the population that had registered themselves with a health insurance cover.

This means that 85 percent of the country’s population was still using hard cash whenever they needed access to health services.

According to analysis of scale-up plans and design, the plan is to have two concurrent schemes, the NHIF and the iCHF.

The NHIF, which has an enrolment of about 3.5 million beneficiaries and aimed to cover the formal sector, will continue to pool funds nationally.

A proposed legislative amendment would make enrolment automatic and mandatory for all formal sector workers. This includes the formal public sector (comprising of civil servants, other government workers, and their dependents) and the formal private sector.

Meanwhile, in March 2018, council management teams and enrolment officers began training for the launch of the iCHF, an alternative insurance scheme to NHIF intended to cover the informal sector and rural households.

The benefit of UHC is not for mere health issues but benefits a range of sectors therefore investing in UHC will impact several Sustainable Development Goals (SDG) such as poverty reduction, equitable health outcomes, quality education, gender equity and inclusive economic growth.

Investing in UHC will reduce the possibility of families being pushed into poverty and families will be healthier.

If productivity strategies are put in place, families will produce and their average expenditure will be above $1.9 (Sh4 400) per day, hence reduction in poverty.

When the household expenditure increases, government tax collection will equally increase. Likewise, a well-designed and financed UHC is a vote-winning strategy.

Every beneficiary will remember times of illness and appreciate how the government took part in addressing health related issues. UHC reforms can be extremely popular with the public as they deliver quick wins.

All beneficiaries covered by the iCHF are entitled to services available up to the regional hospital levels, subject to an exclusion list comprised predominately of specialized procedures and drugs. Access to district and regional hospitals requires a referral letter from primary health facilities.

Project manager for Health Promotion and System Strengthening (HPSS) from Swiss Tropical and Public Health Institute, Mr Ally Kebby said they are happy that the government was making this effort to ensure that every citizen has a health insurance cover.

According to him, under their project dubbed HPSS they developed innovative solutions in partnership with the government and supported their integration into national institutions, systems and policies.

The HPSS project strives to improve access to utilization and quality of health services in Tanzania.

Earlier reports show that most African countries have integrated UHC as a goal in their national health strategies.

Yet, progress in translating these commitments into expanded domestic resources for health, effective development assistance, and ultimately, equitable and quality health services as well as increased financial protection, has been slow.

Countries that achieve their UHC targets by 2030 will eliminate preventable maternal and child deaths, strengthen resilience to public health emergencies, reduce financial hardship linked to illness, and strengthen the foundations for long-term economic growth.

Should understanding and acceptance of these proposed and bettered schemes come to fruition, cases like that of Lightness and Mmari will become a distant unpleasant memory.

However, before rolling out of said medical covers, one major hurdle needs tackling and that is proper education of how these services work.

For many citizens, the major complaint against signing up for insurance is that their money goes to waste as they are denied access to the very services and products they faithfully pay for.

Why are certain services covered and others excluded? Why do some insuraces shy away from covering full body checkups? Why do I have to pay for certain services from my pocket and go through the hustle of filing to get my money back from my insurance?

The questions are many, understaning is little and education from service providers is close to on-existent from where many citizens stand.

Transparency of how funds are dispersed for each service might be more helpful in coaxing individuals to opt for services from insurance providers.