‘Private health insurers are filling gaps in health sector’

These plans are usually PPO (Preferred Provider Organisation) types because they are provided by the employer. They are typically more expensive and offer better coverage than what you could get on your own for the same or a similar cost. 

The benefit is that you have access to a network of doctors and hospitals, including paediatricians and specialists, which is essential for comprehensive care. 

Another benefit of these plans is that the employer will often subsidise them, covering a portion of the employee’s and sometimes even the children’s plans, depending on the employer.

However, there are drawbacks. First, you are dependent on your employer. If you get laid off or if the employer changes the insurance to a cheaper HMO plan the following year, you might have to switch doctors and adjust to a new plan, which is absolutely inconvenient. 

This means you don’t have full control over your plan when it’s tied to an employer. Another drawback is that it can be quite expensive to add your children to the plan. 

These are important factors to consider when evaluating employer-provided health insurance, many health experts believe.

Dan Musiime, Jubilee Insurance Uganda’s chief executive officer says that nearly 95 percent of all medical insurance business written in Uganda is corporate in nature like the aforementioned health insurance plans purchased for staff by their employers. 

And a lot of these policies only cover the staff and exclude their dependents (this could arise out of company policies or budgetary constraints). 

He tells me that most corporate policies limit the number of dependents to four, a figure that needs to be increased because there are relatively many large families in Uganda. A limit of four deters the aforesaid large families general insurance for their healthcare. 

Universal health coverage

The other option for insurance for children is a state-funded insurance programme. Uganda has long dared to have one in the name of the National Health Insurance Scheme (NHIS), which aims to provide universal health coverage to all its populace, ensuring that people have access to necessary health services without suffering financial hardship. 

The scheme is designed to pool resources to cover a wide range of medical services, including inpatient and outpatient care, maternity care, and treatment for chronic conditions. 

However, the implementation and effectiveness of the NHIS have been subjects of ongoing discussion and development, with several failed attempts since 2004.

According to Dr Ruth Aceng, the Health minister, the proposed scheme is designed so that all Ugandans, regardless of age or employment status, will need to pay Shs15,000 per year if the cabinet approves it.

Many healthcare advocates believe there needs to be a mapping to determine people’s affordability. This, they go on to add, is crucial to the scheme’s success. But the government believes that everyone should be able to contribute.

“I’m going now to tell you the sad news. The sad news is that the more the dependants and the more the children, the more you pay because you have to pay for your dependents, nobody is going to pay for your dependants… We need money and when you have money you can get better services,” Minister Aceng said last year.

Child-centric

But as this scheme faces scepticism and bureaucratic challenges, as is common with many state policies, private insurance companies have started offering specific health insurance products for children. 

Jubilee Health Insurance is a pioneer in this area. On July 16, the company launched Uganda’s first children-centered medical insurance product, the J-Junior Medical Cover. According to Musiime, this initiative aims to significantly reduce the financial burden of healthcare on families, specifically targeting children aged 0-17 years.

Currently, just 400,000 Ugandans are enrolled in private health insurance plans, with roughly half, per official government records, being children. 

This comes at a time when healthcare costs are rising sharply. The World Bank’s 23rd Uganda Economic Update Report reveals that out-of-pocket health expenses push one million Ugandans into poverty each year.

Despite this troubling statistic, Uganda has made significant progress toward universal health coverage. 

The proportion of households driven into poverty by out-of-pocket health expenses has been steadily decreasing since 2005, indicating that investments in the healthcare sector are having a positive impact, Mr Musiime says, adding that research shows some serious gaps in the healthcare sector in Uganda. 

“The infant mortality rates can be avoided with the right intervention. Our product was designed to address these gaps in the market by providing comprehensive medical insurance that is also affordable,” he adds.

This cover is designed to address these challenges by providing comprehensive health coverage that includes pre-existing conditions, chronic illnesses, psychiatric care, and more.

“As key healthcare stakeholders, we closely monitor research that informs the state of our sector. We are encouraged by the progress towards universal access to medical care. As part of our company’s effort to significantly reduce out-of-pocket expenses, we will continue to innovate affordable products that meet the diverse health needs of individuals,” says Mr Musiime.

Jubilee Health Insurance data shows that the under-five mortality rate stands at 46 deaths per 1,000 live births, with many children suffering from preventable illnesses due to a lack of timely medical care.

“To promote equity and social justice, we must address mortality rates by offering solutions that ensure children have the opportunity to survive and thrive, regardless of their socio-economic background,” notes Musiime. 

National insurance

Over the years, Uganda’s financing reforms in healthcare have seen many changes. In 1993, the government introduced user fees for public health services as part of broader reforms. 

However, eight years later, President Museveni abolished these fees during the 2001 general election campaign.

While the policy was effective to some extent, it did not fully address the high healthcare costs that many Ugandans still complain about. 

The NHIS Bill, which has been on the House agenda since 2022, has yet to advance. The Health ministry believes that passing this bill is crucial for mobilising additional resources, especially if development funders like the World Bank withdraw their support.

Currently, private health insurers are helping to fill the gaps, but the healthcare sector faces significant challenges. These include inadequate infrastructure in some facilities, limited drug supplies, and low-paid doctors, who are few in public hospitals and often go on strike.