By EDWARD MWANGO
THE National Health Insurance bill presented to Parliament last year by Health Minister, Dr Chitalu Chilufya, has seen heightened debate among stakeholders in the country.
There is a diversity of views expressed on the Health Insurance plan as the bill, which has since passed first reading and referred to the committee on Healtha, Community Development and Social Services awaits a report to be submitted to the House.
While others think it is a positive for the country, some critics view it as an impediment on the already taxed workers.
Whereas the Zambia Federation of Employers (ZFE) and Zambia Congress of Trade Unions (ZCTU) oppose the proposed bill on grounds that meaningful consultations with key stakeholders were not done, their colleagues on the other hand, namely the Health Professions Council of Zambia, Zambia Union of Government and Allied Workers, Zambia National Union of Teachers (ZNUT) and Basic Education Teachers Union of Zambia (BETUZ) have thrown their weight behind the proposed bill.
The proposed bill, presented to parliament by Dr Chilufya last year, is aimed at providing for sound financing of the national health system and universal access to quality insured healthcare services.
According to Dr Chilufya, the bill would further provide for the establishment of the national health insurance scheme, and provide for its systems, procedures and operation.
The National Health Insurance Bill, once passed, will create an institution to be called National Health Insurance Authority (NHIA) that will be given legal mandate to collect money from all workers and employers through the payroll and from every Zambian aged 18 years and above including prisoners.
The money to be collected is said to be used by the government to provide medical services to Zambians through government health institutions.
If the bill is passed quality health care would not only be concentrated in town but also in rural areas.
Bwana Mkubwa Member of Parliament (MP) Jonas Chanda, reportedly wants members of the house to prioritize the passing of the bill during the current sitting which resumed on Tuesday February 20th 2018.
According to Dr. Chanda, the National Health Insurance bill is a non-contentious issue which will enable Zambians access quality health care despite their standing in society hence for members to pass it.
Accordingly health insurance is insurance that covers the whole or a part of the risk of a person incurring medical expenses, spreading the risk over a large number of persons.
By estimating the overall risk of health care and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement.
The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity.
Objects of the National Health Insurance Bill
(a) Provide for sound financing for the national health system;
(b) Provide for a universal access to quality insured health care services;
(c) Establish the National Health Insurance Management Authority and provide for its functions and powers;
(d) Establish the National Health Insurance Scheme and provide for its systems, procedures and operation;
(e) Establish the National Health Insurance Fund and provide for contributions to and payment from the Fund;
(f) Provide for accreditation criteria and conditions in respect of insured health care services;
(g) Provide for complaints and appeals processes;
(h) Provide for the progressive establishment of provincial and district health offices of the Authority;
(i) Provide for matters connected with, or incidental to, the foregoing.
Currently in Zambia provision of health insurance is left in the hands of private health insurers who have pegged exorbitant fees.
This was revealed in a report of the committee on health, community development and social services for the third session of the eleventh national assembly appointed on Thursday 26th September, 2013.
“On the other hand, private health insurance schemes existed, but they were costly and concentrated along the line of rail. Only those who could afford to pay took out private health insurance policies.
“Your Committee learnt that the uncertainty created by the absence of specific reference to health insurance in the law had been exploited. This has led to the establishment of a health insurance market which was poorly coordinated and virtually unregulated leading to frequent entry and exit of private insurance schemes in the market,” the report reads in part.
The report also highlights numerous constraints affecting the effective provision of Public and Private Health Insurance in the Country among which were poor data management systems by both insurers and healthcare providers.
Accordingly this leads to difficulties in carrying out reconciliations and ultimately delays the settlement of claims.
Related to this constraint was the lack of Information and Communication Technology (ICT) systems that could improve data management and allow interface between insurers and health service providers.
Such systems were said to be so expensive that both health insurers and healthcare providers were reluctant to procure them.
Other constraints cited were poor health insurance market regulation which led to the emergence of unlicensed insurers who engaged in unfair business competition with licensed insurers.
“Fraud, sometimes involving both staff and policy holders. The use of a manual claims system by some insurers further complicated the situation by making it difficult to notice on time when insured persons overshot their limit.
“Lack of public confidence in health insurance which was mainly attributed to insurance firms that had undergone liquidation, “the report reads in part.
According to the report, concern had been raised that private health insurance providers were not properly regulated to ensure adherence to minimum standards.
In addition, the report noted that there seemed to be no clear policy and legislation governing the provision of health insurance in Zambia.
And according to the report on consolidated summary of stakeholders’ submissions, the Committee was informed that Zambia does not have a stand-alone policy on health insurance and there was no explicit reference to health insurance in the current law, the Insurance Act, No. 27 of 1997.
The Pensions and Insurance Authority (PIA), which is the regulatory authority, categorises health insurance as long-term insurance. Thus, it is treated as such even for purposes of regulation.
Stakeholders further informed the Committee that the inadequate provisions for health insurance in the law had negatively affected the sector in terms of compliance and quality of service.
Some health insurance providers were not registered and therefore were not regulated by the Pensions and Insurance Authority. On the other hand, some insurers were not offering the minimum standard package of benefits. “Your Committee was also informed that the Government had consulted widely with various stakeholders on the establishment of the National Social Health Insurance Scheme. Further, an actuarial assessment was conducted in 2012 that showed that the National Social Health Insurance Scheme would be financially viable and sustainable. In this regard, a National Social Health Insurance Bill had been drafted and discussed at provincial level consultative meetings. “Your Committee learnt that the uncertainty created by the absence of specific reference to health insurance in the law had been exploited. This has led to the establishment of a health insurance market which was poorly coordinated and virtually unregulated leading to frequent entry and exit of private insurance schemes in the market,” the report further reads.
Stakeholders are keenly keeping a close eye with their ears to the ground awaiting the outcome of this contentious bill expected to be tabled in the house during this second session of the 12th National Assembly, which adjourned sine die on Wednesday 13th December 2017.