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Preparing for National Health Insurance

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Added 24th July 2019 02:08 PM

A chronic condition is any condition that requires ongoing adjustments by affected person and interactions with the health care system.

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A chronic condition is any condition that requires ongoing adjustments by affected person and interactions with the health care system.

By Sharifu Kiragga Tusuubira
 
Recently, a parent reached out to Uganda Sickle Cell Rescue Foundation complaining that his insurance company is requesting him to pay more than 300% his original premium for his year and a half son.
 
The insurance company claims that this young boy is over-utilizing the service.
 
In an effort to find a solution, the parent reaches out to another insurance company to take up the son. The company turns down the request on grounds that caring for sickle cell as a chronic condition is expensive and as such is not covered under their premiums.
 
A chronic condition is any condition that requires ongoing adjustments by affected person and interactions with the health care system. This can be a mental or physical condition that lasts more than one year and requires ongoing treatment. Such conditions include diabetes, high blood pressure, obesity, sickle cell, HIV, and asthma among others. In Uganda, such chronic illnesses account for 33% of all deaths. 
 
These conditions require a form of care whose primary goal is to help patients, via treatments and interventions, to live with less pain or difficulties related to their chronic conditions. Everyone has a friend or relative that has lost a limb or become blind due to uncontrolled the blood sugar; or someone who has died from stroke due to high blood pressure not properly managed. Thus, chronic care is aimed to achieve a better quality of life through ongoing care and management of these conditions.
 
In Uganda, there is little understanding of how chronic care services are and should be provided particularly at the lower level health facilities. While we have made significant progress in disease‐specific chronic care programs targeting people with HIV infection, other chronic diseases do not have any structured care programs. Like HIV, most other chronic illnesses require similar responses from the health system; notably a regular long‐term follow‐up of patients and an uninterrupted provision of medicines. The good news, from the research we know that the annual total costs for HIV services are much higher than the combined total cost of other chronic illnesses.
 
Ministry of health is concerned about healthcare expenditures associated with chronic care and how best to provide services within their scarce resources to meet the growing added demand. However, research indicates that chronic care decreases overall cost burden of disease management.
 
Health care providers cannot provide a one-size-fits-all approach as this form of care might depend on the patient and the illness.  For different illnesses, this could mean reduced pain, better sleep, reduced stress or better physical endurance.  Chronic conditions are complicated; thus, they require more frequent, longer and more in-depth medical visits. In addition, due to the nature of chronic illnesses, a given treatment may be more or less effective, depending on the stage of illness.
 
Research indicates that chronic illnesses are associated with fewer workdays and lost productivity.  Indeed, even the onset of a chronic condition can take somebody out of the workplace, so that has an effect on the family income. However, research further indicates that prevention is much less expensive than treatment, but the caveat is that habits and health behaviors can be really difficult to change.
 
The management of chronic conditions requires the transformation of our healthcare system. This will be essential to address shortfalls like a lack of active follow up to ensure the best outcomes; a lack of care coordination and planned care; health care workers who do not follow appropriate treatment protocols and above all patients inadequately trained to manage their conditions.
 
Overcoming such shortfalls will require nothing less than changing our health system from a reactive system which responds when a person is sick to a more proactive system focused on keeping a person as healthy as possible. It is like when someone falls into the river flowing downstream, is it better to save them at the time of falling into the river or wait will they get downstream? Our health system, for now, waits for you downstream when considerable damage has occurred and might not be reversed.
 
To date, Uganda is the last East African country to adopt national health insurance. This national scheme is being promoted to reduce the high out of pocket spending and offer a policy path for equitable access to universal healthcare. In lieu, it is incumbent for the government to increase the national spending on health to at least 15% of the national budget in alignment with the Abuja Declaration. It will also be essential to address the medicine availability in public facilities which often leads patients to pay higher prices to acquire medicines at private pharmacies.
 
This national health insurance will serve as part of social health protection to save lives and shield people against poverty. Since people become sick or die from preventable and curable illnesses, mostly because they cannot afford.
 
Commercial health insurance firms continue to bridge the gap; however, their costs are often prohibitive for the majority of the population. Yet, providing access to affordable, equitable and ethical health services can alleviate the financial burden which in turn help people generate income.
 
In conclusion, it is essential that all stakeholders in health service delivery focus on affordability and access for all especially for persons in need of chronic care services.
 
The author is a technical advisor at the Uganda Sickle Cell Rescue Foundation.

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