Community health insurance

Although Ssempa says he was initially skeptical because of his earlier experience, this scheme has offered him real cover.

“I first got treated for malaria. A few days later my son fell sick and had to be admitted and when he was still there my mother was also admitted. I got scared but at all times I was only asked to present a card.”

In reality, the scheme does not cover critical illnesses, elective surgeries, and self – inflicted injuries. If a treatment episode exceeds Shs250,000 a patient has to pay extra funds out of pocket. But Ssempa and other members still see community health insurance schemes as life savers. As a result, the schemes which started in Luweero District in central Uganda have expanded even in areas where government hospitals offer free medical care.

Makaire’s Save for Health Uganda groups its schemes into three; the rural communities schemes where members pay premiums of Shs20, 000 per year,urban informal communities, who pay Shs50, 000 per year, and corporate formal communities where members part with Shs85, 000per year. This covers outpatient, inpatient, and maternity services, and surgeries, dental and eye care services.

Lessons for government

The growth and popularity of informal community health insurance schemes contrasts sharply with the lack of interest in the formal private insurance schemes. Figures from the Uganda Healthcare Federation, an umbrella body for private healthcare providers, show that only about 150,000 people out of a population of over 36 million in Uganda are health insured.  Most of these are not subscribed as individuals but as work place policies; where companies they work for enroll them on the plan.

Though people are enrolling steadily for the informal schemes, many fear they might be cheated because the schemes lack formal contracts and are run purely on the basis of trust. If clients’ medical fees are not paid, they have nowhere to seek redress as happens with private commercial health insurance that is overseen by the Insurance Regulatory Authority. This is mainly because informal schemes do not meet the statutory requirements for how much money they must keep on hand to ensure they are able to cover the medical claims of their members. But people like Ssempa do not care. All they want is care.

“When I fall sick, I just carry my card. If there is an extra I pay the money and get my drugs,” he says.

And Dr. Diana Atwiine, the Permanent Secretary in the Ministry of Health, says community health insurance schemes are unlikely to be covered initially in the proposedNational Health Insurance Bill to be tabled before cabinet this month.

She says the proposed law will cover formally employed groups who will subscribe either under social health insurance or the private health insurance scheme and will have 4% of their salaries deducted to finance the scheme.