Analysis: HERRYMAN MOONO
AFTER taking a few cups of Shake Shake, I had an enlightenment moment and thought I should share with you how you could appreciate the National Health Insurance Bill (NHIB) in light of motor vehicle insurance.
For those of us who don’t own cars, and thus don’t know about insurance, please bear with me.
Rejection of the National Health Insurance Bill is synonymous with sentencing the poor to permanent ill health and death.
So let’s start.
When you buy a car, it is mandatory that you buy motor vehicle insurance. You can buy comprehensive insurance or third party insurance, depending on your pocket.
Comprehensive insurance will cover the full costs of replacing your vehicle in the event of an accident and will cover all other costs related to the accident. What this does is that it ‘protects you financially’ in the unfortunate event of an accident.
So imagine, you have a car worth K100,000 and you only pay K5,000 a year for comprehensive insurance, yet, when you have an accident, you get the full K100,000 to replace your car – now, what more can you ask for?
But where does the insurance company get the money from to buy you a new car when you only paid K5,000 towards insurance?
Answer: It gets the money from a ‘pool’ of people that insure with them. So, there are many other people insuring their cars with the insurance company, all of them paying their contributions (premiums).
These contributions are then ‘pooled’ in a fund from which anyone who has an accident is paid from. The principle of insurance is based on the reality that not everyone will be involved in an accident at the same time, and so those who are unfortunate and have an accident will be covered by the contributions of those who have not had an accident.
What car insurance does is to ‘spread the risks of accidents’ as well as ‘spread the costs’ across the insured so that no one individual will have to bear the full burden in the unfortunate event of an accident.
Now in the case of an accident, when one makes a claim, the insurance company will give you the option of selecting a garage that will assess your car and repair costs. These garages will be ‘accredited’ garages chosen by the insurance company as having met their criteria to provide quality car repair services.
Once settled on the costs, the insurance company will pay the chosen garage’s bill for repairing your car. You do not have to pay anything at all, all this is between the garage and the insurance company. Once your car is fixed, you go get it and go back to your daily life without incurring any cost beyond the annual premiums you pay.
If for some reason you are not happy with the work of the garage, you can complain to your insurance company, which will choose another garage for you and may choose to no longer work with the garage that offers inferior service.
Now this is almost exactly how the social health insurance will work:
1. Government, through the National Social Health Insurance Management Authority (NSHIMA), will choose healthcare centres or hospitals to accredit to provide health care for people under the scheme – think of these health centres as garages.
2. People will insure their ‘health’ against illness by contributing to the National Health Insurance Scheme, through salary contributions (like NAPSA) and other means.
3. Those who contribute will have an ID card, like a car insurance disc, which they present to the accredited hospital for any treatment at any point that they fall sick and they will be treated without paying for anything – including medicines. This will include both public and private health care providers.
4. The health care centre that treats people will then bill NSHIMA, just like the garage will bill the insurance company.
5. Concerns on the quality of care will be determined in the accreditation – all chosen health centres will have to meet minimum standards of quality that should reflect value for money.
6. The addition to National Health Insurance, however, is that Government will subsidise the poorest people in society by waiving contributions yet these people will have access to the same quality and quantity of care as those who contribute. This is the key principle of redistribution: no one should be denied access to quality health care on account of their economic status in society. This, colleagues, is in pursuit of Universal Health Care.
7. What is important to note is that with health insurance, you do not pay the full cost of health care because, like in the case of car insurance, not all who are contributing are likely to fall sick at the same time.
8. Those who wish to have private health insurance can continue to do so – just like one insures with ZSIC, others insure with Madison for their cars – it’s your choice. But to support the attainment of universal health coverage and ensure that we cover even the poorest in our society, national health insurance shall be mandatory for all.
9. The good thing is that money from national health insurance is not the only cash that will be available to support our health care system. Government funding that we have now will continue. What this means is that we will have more money available for our healthcare system. This will improve both the quality and quantity of care.
10. Our issue should be that we ask the Auditor General to be strict with the auditing of NSHIMA and ensure that money is used for the intended purpose. This is where civil society, opposition and ruling party MPs come in handy in providing checks and balances.
Interestingly, however, I note that people that are against this bill are the ‘us’ who are formally employed – we do not wish to subsidise our poor in society, which beats the principle of redistributive justice and solidarity.
If we suspend the bill, we will be sentencing the poor to permanent ill health and death.
Remember, we cannot fix the economy if we cannot health-care.
The author is an economic analyst with expertise in health care financing and development policy.
Analysis: HERRYMAN MOONO