At every hospital visit, it’s commonplace for clients covered by medical insurance to flash physical biometric cards. Some clients are often denied services if they lost their cards or didn’t carry them to the medical facility.
To create an effortless healthcare management system, Smart Applications International (U) Limited launched a virtual mode of accessing medical insurance at the Sheraton hotel in Kampala last week.
According to the country manager for Smart Applications International, Judy Mugoya, the virtual experience aims to enhance the patient experience, provide healthcare on the go, instant onboarding support to medical insurers, and transparency in healthcare administration.
Clients will also know their medical cover balance, track medical cover utilization, locate medical providers, initiate hospital visits, and read health-related content on the application.
“Most times, we go to the hospitals without prior information about our insurance covers. You will also, in real-time, know the benefits of your family members that are often hidden under normal insurance schemes,” Mugoya said.
She added: “The members will also initiate hospital visits. Gone are the days when one forgets their medical card at home and is denied service. Once a visit code is presented at a health facility, they open up your visit and the normal process takes effect without wasting time to fill more paperwork.”
While the Smart Access App is online, persons using feature phones can initiate hospital visits using short unstructured supplementary services data (USSD) codes. Mugoya said the application was developed following several challenges in medical insurance such as some beneficiaries being unknown to health facilities, clients unaware of their covers, and an ongoing “war” of facilities offering services and insurers failing to settle their claims.
Smart Access is implemented by 728 health facilities in 92 districts in Uganda. At least 30 insurance players and private organizations with in-house medical schemes have also been on-boarded since January 2023. Overall, 255,000 consumers are using the application.
CURB MEDICAL FRAUD
Before the onset of Smart Access, there has not been a fully integrated system where the medical services providers, insurers, and clients access information at the click of a button.
According to the chief executive officer of the Uganda Insurers’ Association (UIA), Jonan Kisakye, more than 30 per cent of losses under medical insurance result from manual processes.
“Fraud under medical insurance is a big problem and all of us are guilty; the insurers, members, and service providers. Where there’s paperwork, the potential for fraud is high. We delay paying service providers because of the manual systems that need to be eliminated,” Kisakye said.
He added: “It is unfortunate that if you walked into any service provider with your card, you would be forced to fill in documents whose information is already on your card. Why are we operating like that in this digital era?”
In his keynote address, Kisakye noted that most of the UIA members providing medical insurance are operating in losses because “if 90% of the premiums that you receive are paid out as claims, how do you sustain the business?”
He believes that once manual processes are eliminated, companies can lower the loss ratios and then focus on pricing issues by service providers.
“The sustainability of medical insurance depends collectively on all members to digitize and automate their processes. This will translate into timely payments, appropriate pricing, better packages, empowered customers, and a decent return on investments for the shareholders,” he said.
Heather Mugabi, an underwriter (medical) at UAP Insurance, urged the developers of the app to carry out more sensitization drives about the innovation as transition from the physical to virtual cards may not come easily.
“So far, the app is an efficient one. As UAP, we are phasing out the physical cards soon because although the population has not yet embraced the virtual systems, we shall completely go virtual with time,” Mugabi said.
HIGH TREATMENT COSTS
Statistics from Smart Applications International Uganda indicate that the average cost of healthcare recovery has marginally increased from 2020 to date.
For instance, at the onset of the Covid-19 pandemic in 2020, hospitals averagely charged Shs 80,035 for out-patient services, Shs 48,260 for drugs, Shs 31,827 for laboratory fees, and Shs 37,374 to see a health specialist.
In 2022, health facilities were charging as high as Shs 1.2m and Shs 88,616 for in-patient services and out-patient services respectively. The cost of drugs also jumped to about Shs 54,325, laboratory fees 33,786, while patients paid a minimum of Shs 66,450 to see a specialist.
Top diagnosis out-patient traffic was cited in acute respiratory infections, malaria, bacterial infections, hypertension, dental carries, antenatal screening, and pharyngitis.
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