The benefits of Health Insurance and technicalities of services

YOU can be treated using your health insurance card, but once you die, the insurance does not cover mortuary services.

These are words which were overheard from a Mwanza resident who was in a dilemma after losing a family member who was using health insurance.

He was stuck after he was told that the insurance policy covers all medical expenses accrued by the deceased patient, but mortuary expenses should be paid from their pockets. He says that it would be helpful to most Tanzanians if the health insurance schemes should include mortuary services when members die in a hospital.

It is during a meeting for public awareness over the Universal Health Cover (UHC) bill where they were informed that services end when a member dies.

The meeting that was organized by the Ministry of Health and involved among others, key groups like religious leaders, fishermen, peasants, entrepreneurs, petty traders as well as motorcyclists commonly known as ‘bodaboda’.

“Currently the costs for mortuary services are covered by family members,” said a member of the National Muslim Council of Tanzania (Bakwata) in Mwanza, Mr Twaha Utali, “We now request the government to include that requirement in the UHC not only for a principal member, but also dependents, until the dead body is handed to family members,” he proposed.

The meeting participants also aired their views over the importance of herbal medical treatments, saying that UHC should cover the costs as long as the service provider has been registered.

Tanzania Fisheries Union (TAFU) Spokesperson, Mr Sijaona James said that some people prefer traditional medicines to modern medicines, therefore they should also be included in UHC so that people can have a wide choice of treatment.

According to them, there is also need to review the number of beneficiaries from the current six in a household to an unlimited number, because some families have ten or more children each.

“Again, it is important to set up the amount of money to be paid by members under UHC, for public discussion before the Bill is passed,” recommended Mr James.

The residents further said that contributions for UHC can be derived from the available natural resources incomes, be it from minerals or tourism sectors. Once the idea is accepted, then the government should choose a single element of minerals, such as diamonds, for instance, whose incomes should be channeled towards UHC fund as contributions for all citizens.

“This is one of the ways we can benefit from our natural resources, let the government work on this opinion,” he proposed.

It was further noted that the UHC Bill involves the Standard benefit and additional services packages, where the meeting participants demanded to know the difference and explanation on how they (packages) cannot create classes in the society.

Responding, the Ministry’s Permanent Secretary (PS), Prof Abel Makubi, explained that the former (package) is for basic services in which every insurance scheme must offer for every citizen. It involves among others, registration and health tests charges, types of drugs on National Essential Medicines List (NEMLIT), minor, middle and specialty surgeries by experts, admission, oral and dentals as well as eye care services.

Orthopedic appliances and physiotherapy services are part of Standard Benefit package, according to Prof. Makubi. The second package is for a person in need of additional services, such as having medical treatments or health checkups abroad, together with dependents and will be paying additional charges. “She/he can also select a flight to fly with,” said the PS.

Prof Makubi urged the residents consider joining UHC once approved by Parliament, because the scheme is for among other benefits, setting the majority free from poverty.

He said this is because some people sell their plots or livestock so that they can get money for medical treatment, which plunges them into poverty, stressing that this universal scheme will address such challenges since the costs are to be covered before one has fallen sick.

The PS directed relevant authorities, including Regional and District Medical Officers, to intensify public awareness on the importance of UHC, so that all members of the community can have equal and clear understanding over the matter.

He said that for those proven completely unable to cater for medical expenses, the government will make their medical contributions to UHC. The Director for Legal Services in the Ministry of Health, Mr Rahib Mashombo, said that the amount of money to be contributed by members from the informal sector was yet to be included in the Bill, to give room for any changes.

He clarified that when the amount is mentioned in the Bill, when there are necessary changes then the matter will need to be taken to Parliament for approval.

“To ease such a process, the responsible Minister has been given power to make any necessary changes at any time,” he said.

However, he added that the amount for the formal sector has already been set, which is six per cent where an employee is required to cover not beyond three per cent.

NHIF Director for Membership Services, Mr Christopher Mapunda, commented on limited dependents’ number, saying that the existing laws direct for only six family members.

However, he said that the Fund has been making some improvements, with the number (six) being composed of not only the principal member’s biological children as it was the case previously, but also other blood relatives as long as no dependent is beyond 21 years of age. He also responded on herbal treatments, saying that the issue is in discussion, since some scientific medicines, including ‘aru’ are made of herbs.

“More improvements will take place according to how NHIF laws are reviewed,” he said.

Presenting on the originality of the Bill, the member of UHC committee in the Ministry of Health, Ms Jackline Tarimo said that it is the government’s constitutional responsibility to make sure that all the citizens have a smooth access to quality health services.

Figures show that a large number of citizens, approximately 85 percent, do not have health insurance cover, facing uncertainty of services when they are in need.

At the same time, she added, existing laws set citizens’ voluntarism in both informal and private formal sectors to join insurance services, as a result, majority do so after they have fallen sick.