Poverty hinders health insurance growth
Feb 07, 2009
MICROCARE Health Insurance is one of the private providers of health insurance services. <b>Lucas Greyling</b>, the managing director, told <b>James Odomel</b> the challenges facing the industry.
MICROCARE Health Insurance is one of the private providers of health insurance services. Lucas Greyling, the managing director, told James Odomel the challenges facing the industry.
QUESTION: What are the top issues affecting health insurance in Uganda?
ANSWER: The most important issue is that the average per capita income in Uganda is still low in spite of the impressive economic growth in recent years. The majority of families still struggle to pay for quality medical services.
Secondly, the fact that only a small percentage, particularly in the rural areas, can afford quality medical services makes it difficult for doctors to make a living. As a result many areas in the country are under-serviced. On average, there are 13,000 patients per doctor.
Thirdly, the cost of drugs also keeps rising due to increasing transport costs, higher dollar rates and imported inflation. This is an area in which support for locally-manufactured medicines can help in reducing the cost treatment.
About 25% of the population access average health facilities and services. Where is the problem?
The issue of low density of medical facilities is also due to the low per capita income I referred to earlier. When people earn better incomes, they are able to afford medical services. This fosters the development of better facilities.
With a wide network (over 170 service providers countrywide) like yours, managing relationships and maintaining quality service must be difficult. How do you select the providers to work with?
We ensure that the medical staff are qualified and the facility must be licenced by the health ministry. We also ensure our partner clinics adhere to hygiene and regulations for the disposal of medical waste.
This is vital because we don’t want medical waste to pollute the environment or endanger people’s lives.
Our partners must also follow the best clinical practices according to the World Health Organisation and the health ministry guidelines and adhering to contractual obligations.
Have you had cases where clients have complained of the quality of service?
Providing health insurance requires a good working relationship between a number of parties – mainly the insured person, the medical provider and the insurer.
Each party has to play its part to ensure successful outcome. Sometimes this partnership develops difficulties, which are usually dealt with through improved communication.
In rare cases, it also requires the replacement of a provider.
I understand health insurance companies do not want to cover conditions like HIV, diabetes and heart diseases. What is your stand on this as Microcare?
If a risk can be managed, it can be insured. That is why Microcare was the first health insurer to provide cover for HIV and chronic conditions.
Some risks like attempted suicide are not insurable. These, unfortunately, have to be excluded.
There are reports that you don’t pay providers, causing clients to be denied treatment. How have you handled these cases?
We pay our suppliers for legitimate claims according to agreed contractual terms. However, we also have a responsibility to screen all claims for over charging and fraud, which is a problem for the insurance industry worldwide.
Without screening, the cost of health insurance will become unaffordable for ordinary people.
When some providers are caught they try to create the impression that the insurer is at fault. This is not the case.
In some cases, such claims become subject to arbitration or litigation. Microcare has never been found to be at fault.
What is your relationship with your health providers?
We have a network of more than 170 medical service providers throughout Uganda, the most extensive network of providers of all regulated or even unregulated health insurers in the country.
Our financial contribution has been very significant. We therefore have an excellent relationship with our service providers.
There will always be a few problem cases, which we also have, but these are the exceptions.
Businesses in Uganda are starting to feel the effects of the global financial crisis. How will you handle the situation?
Microcare will continue to build on our core strengths. We only do health insurance unlike our competitors who do health insurance as a small sideline to their core business. We have one of the best IT systems for health insurance anywhere in the world, combined with internationally recognised specialists.
in our field.
As the biggest health insurer in Uganda we also have one of the most important requirements for effective risk management, which is economy of scale. This means that we will continue to deliver affordable access to quality healthcare long into the future.
QUESTION: What are the top issues affecting health insurance in Uganda?
ANSWER: The most important issue is that the average per capita income in Uganda is still low in spite of the impressive economic growth in recent years. The majority of families still struggle to pay for quality medical services.
Secondly, the fact that only a small percentage, particularly in the rural areas, can afford quality medical services makes it difficult for doctors to make a living. As a result many areas in the country are under-serviced. On average, there are 13,000 patients per doctor.
Thirdly, the cost of drugs also keeps rising due to increasing transport costs, higher dollar rates and imported inflation. This is an area in which support for locally-manufactured medicines can help in reducing the cost treatment.
About 25% of the population access average health facilities and services. Where is the problem?
The issue of low density of medical facilities is also due to the low per capita income I referred to earlier. When people earn better incomes, they are able to afford medical services. This fosters the development of better facilities.
With a wide network (over 170 service providers countrywide) like yours, managing relationships and maintaining quality service must be difficult. How do you select the providers to work with?
We ensure that the medical staff are qualified and the facility must be licenced by the health ministry. We also ensure our partner clinics adhere to hygiene and regulations for the disposal of medical waste.
This is vital because we don’t want medical waste to pollute the environment or endanger people’s lives.
Our partners must also follow the best clinical practices according to the World Health Organisation and the health ministry guidelines and adhering to contractual obligations.
Have you had cases where clients have complained of the quality of service?
Providing health insurance requires a good working relationship between a number of parties – mainly the insured person, the medical provider and the insurer.
Each party has to play its part to ensure successful outcome. Sometimes this partnership develops difficulties, which are usually dealt with through improved communication.
In rare cases, it also requires the replacement of a provider.
I understand health insurance companies do not want to cover conditions like HIV, diabetes and heart diseases. What is your stand on this as Microcare?
If a risk can be managed, it can be insured. That is why Microcare was the first health insurer to provide cover for HIV and chronic conditions.
Some risks like attempted suicide are not insurable. These, unfortunately, have to be excluded.
There are reports that you don’t pay providers, causing clients to be denied treatment. How have you handled these cases?
We pay our suppliers for legitimate claims according to agreed contractual terms. However, we also have a responsibility to screen all claims for over charging and fraud, which is a problem for the insurance industry worldwide.
Without screening, the cost of health insurance will become unaffordable for ordinary people.
When some providers are caught they try to create the impression that the insurer is at fault. This is not the case.
In some cases, such claims become subject to arbitration or litigation. Microcare has never been found to be at fault.
What is your relationship with your health providers?
We have a network of more than 170 medical service providers throughout Uganda, the most extensive network of providers of all regulated or even unregulated health insurers in the country.
Our financial contribution has been very significant. We therefore have an excellent relationship with our service providers.
There will always be a few problem cases, which we also have, but these are the exceptions.
Businesses in Uganda are starting to feel the effects of the global financial crisis. How will you handle the situation?
Microcare will continue to build on our core strengths. We only do health insurance unlike our competitors who do health insurance as a small sideline to their core business. We have one of the best IT systems for health insurance anywhere in the world, combined with internationally recognised specialists.
in our field.
As the biggest health insurer in Uganda we also have one of the most important requirements for effective risk management, which is economy of scale. This means that we will continue to deliver affordable access to quality healthcare long into the future.