The Insurance Regulatory Authority (IRA) has clarified that not all individuals will pay a monthly charge of 15,000 Shillings per month and the same amount per year for the indigents in the proposed National Health Insurance Scheme whose bill is about to be debated by the cabinet.
While Health Minister Dr Jane Ruth Aceng had earlier revealed that every Ugandan has to pay that amount for both themselves and their dependents, Ivan Kilameri an Actuarial Manager at the Authority clarified that employees in the formal sector will contribute a percentage of their salary as they have established bands categorizing what will pay depending on what they earn. This money will be deducted by employers at source.
Kilameri who was speaking at a meeting that discussed the feasibility of the coming scheme revealed that only those formal workers who earn 235,000 Shillings or less will be expected to pay fifteen thousand shillings, adding that even refugees will have to pay the same amount in the new proposals.
According to IRA, contributors will have a benefit limit of up to one million shillings for outpatient care and five million for inpatient services and they explain that costing has been guided by claims experiences from community health insurance schemes which are thriving in different parts of the country and benchmarking from elsewhere in countries that have a working public scheme.
Kilameri adds that while community schemes are voluntary, everyone will be coerced to contribute to the new scheme with the proposal currently being that IRA will provide oversight.
However, while these proposals will be tabled soon, sections of Ugandans already express reservations fearing that this money could be swindled.
Dr Robert Kalyesubula a senior lecturer at Makerere University and doctor at Mulago Hospital said that while a public insurance scheme would come in handy considering the current huge out-of-pocket expenditure on health, people need not be coerced to pay.
For him, the issue of choice is key, and people should be given a good reason to contribute other than making something that they don’t appreciate mandatory especially when the government has previously not been very accountable.
The same feelings are shared by Timothy Chemonges a Policy Analyst who says that before introducing the same, policymakers need to first ensure that the fee is inclusive and that the public will be able to understand why they will be parting with the money.
He worries that the scheme might face resistance especially since the question of corruption has not been well addressed in the country with recent concerns raised and suspicions on what is going on with the National Social Security Fund (NSSF) which uses the same approach of savers contributing money.
Dorothy Amuron, a lawyer at an NGO Center for Health, Human Rights and Development (CEHURD) suggests that the Ministry of Health should come up with strategies for buying public trust.
According to her, a feasibility study needs to be done to assess public trust and also do more benchmarking such that the scheme doesn’t hit a dead end after many years of trying.
Meanwhile, a push to have a National Health Insurance Scheme has been on for more than twenty years but efforts have always stopped the drafting of the bill.
The latest attempt was in 2021 when the piece of law was withdrawn shortly after being passed by parliament. The government cited gaps that needed to be addressed after thorough consultations with stakeholders.
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