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Passed NHIS Bill still has gaps to be addressed

On March 31, 2021, Members of Parliament passed the National Health Insurance Scheme (NHIS) bill, which seeks to provide universal healthcare to all Ugandans.

However, before its’ passing, the state minister of health Robinah Nabbanja had made it clear to the House that the bill in its current state needed to be withdrawn, pending consultations from stakeholders.

My feeling, though, is that instead of withdrawing the bill, the minister ought to have asked for some more time before parliament considers the bill.

Nonetheless, the minister informed the House that there was still need to carry out an analysis of the premiums on how much and what percentages the formal and informal employees and employers would contribute to the scheme.

She informed members of the august house that implementation of the scheme was pending an ongoing actuarial study undertaken by the Insurance Regulatory Authority of Uganda (IRA), which is a key outstanding issue that will largely affect universal enrollment of the population to the scheme.

The IRA and the insurance industry are in support of the fundamental principle of establishing the scheme because it will safeguard families from financial hardships as a result of huge medical bills.

We are all aware that our total health expenditure or budget is currently at close to Shs 8 trillion. Given the country’s population explosion, the demand for health services and facilities is increasing every other day.

Over the years, we have noted that the out-of-pocket expenditure on health for an individual in Uganda currently stands at 41 per cent yet any out-of-pocket expenditure that goes beyond 10 per cent is catastrophic. It basically implies that families are not having enough resources to cater for other basic needs like food, shelter and clothing, among others.

We have on various occasions witnessed patients being detained in hospitals and health centers for failure to clear their medical bills. Others, especially expectant mothers, have not received the necessary attention for failure to have the basic need like “mama kits” to facilitate the nursing team at the health facilities to support them while delivering their babies safely. The scheme is meant to address and safeguard families in such instances because the patient will not need money at that time in order to access essential health care.

As government rallies the country into the middle-income status, with the scheme in place, households shall be protected from impoverishment due to high expenditures on health and saving from medical expenses, which will be channeled to domestic development. In addition, members of the scheme will be able to access facilities that are accredited on the scheme at their convenience.

Whereas members of parliament and government are setting the right direction in establishing the scheme, it’s important that the implementation of this scheme takes matters of professionalism, technical design, affordability for the common person, total transparency (especially financially) and sustainability through reduced administration costs into consideration.

To ensure good implementation of this scheme, there is need to identify and cluster people affected with minimum benchmarks set through development of regulations and guidelines.

Whereas the scheme shall be overseen by the board, it is important that it is supervised by a regulator to ensure professionalism, adherence to best insurance practices and adoption of suitable technical scheme designs. This will create confidence in the scheme and acceptance by the public and ensure the funds remain solvent.

We have recommended that this being medical insurance service provision, it should be managed in accordance with the Insurance Act. Just like in other jurisdictions such as Kenya, the Health Insurance Scheme is supervised and regulated as per the Insurance Act.

This, therefore, requires a review of Section 30 and 31 of the bill as passed. This will ensure continuity of the scheme, value for money and quality service provision for members since the parameters on provisioning, investment, market conduct and service provision standards are already set. Ultimately, the rights and obligations of the contributors are protected and safeguarded.

In the East African region, insurance penetration is considerably higher in other partner states compared to Uganda because these states have diversified and strengthened health care financing through the schemes’ contributions.

So, rolling out a similar initiative shall definitely deepen insurance penetration in Uganda and put us at par with our neighbours. Lastly, before the scheme is operationalized, there is need to reconsider section 26 (2) (b) of the bill, which exempts treatment of injuries incurred as a result of accidents or occupational illness.

This runs counter to and shall defeat the purpose of the scheme because a person involved in a motor accident or suffering an occupational illness from their place of work, shall not benefit from the scheme yet they need medical attention critically at that point.

In addition, section 57, which looks at Community Based Health Insurance Schemes and Section 45 which looks at establishing Regional Health Appeals Tribunals, all need to be reconsidered and refocused.

Otherwise, with a few Ugandans insured under private medical schemes and others under community or village-based health insurance initiatives, membership to the scheme should be compulsory for all in order to promote social solidarity and the pooling of resources so that everyone is insured irrespective of their financial and physical health.

And as such contributions must not be seen as a tax but as an avenue to acquiring medical insurance is an essential safety net given the increased occurrence of pandemics and non-communicable diseases.

As the insurance regulator, we want to encourage Ugandans to be receptive and supportive of the scheme and assure you of our commitment to ensuring that you get value for your contributions.

Chief executive officer, Insurance Regulatory Authority of Uganda.

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