Zambians to start paying close to K2, 000 mandatory annual health insurance fees by 2015
Zambians working in the formal sector are expected to start paying about K2, 000 per year per person if the proposed Social Health Insurance scheme is implemented by 2015.
Findings by the Zambia Civil Society Health Forum have shown that for workers in the formal sector, the average annual contribution could be as high as K1,423 (US$270) by 2015 if the Social Health Insurance scheme gets underway.
In a presentation at a recent health conference in Lusaka, the Zambia Civil Society Health Forum revealed that the figures are based on a 2008 actuarial analysis which calculated that in order for the scheme to be financially viable, a family of six would be contributing around K120 (US$22) per month – just under K20 (US$4) per person.
The SHI scheme will be phased incrementally with public servants being the first to enrol on a mandatory basis, followed by formal sector employees.
The large group that makes up the informal sector will be the last to join, with membership of the scheme arranged on a voluntary basis initially.
If this happens anyone not enrolled in the SHI scheme would not be entitled to receive free health services.
The Zambian SHI scheme will consist of a single fund that will be administered by a central quasi-government agency.
The agency, which will be created by an Act of Parliament, will be responsible for overseeing the enrolment of new members, accrediting health service providers, and processing claims.
Funding will come from three main sources namely the payroll deductions from the formal sector (shared equally by the employee and employer), direct contributions from the informal sector through an annual premium, and general government revenue to cover ‘exempt’ groups.
The PF government is moving swiftly to introducing a Social Health Insurance scheme aimed at facilitating Universal Health Coverage and improving the financial sustainability of the health sector.
The Zambia Civil Society Health Forum however noted that there is a real risk that the planned SHI scheme will not achieve these objectives.
The Forum observed that in practice, other countries that have taken a similar approach have had little success in extending coverage and all too often the poor and vulnerable left excluded.
It said in low-income countries, introducing complicated and expensive systems to collect insurance premiums from the largely poor informal sector is both inequitable and inefficient.
“Insurance contributions from the informal sector rarely raise much revenue; in Ghana premiums paid by the informal sector contribute just 5% towards the cost of the National Health Insurance Scheme (with over 70% of the funding coming from a levy on VAT),” the Forum points out.
It added, “there are also significant costs involved in administering the scheme, this would involve marketing and promotion activities, collecting premiums (sometimes door-to-door), and managing renewals. In Kenya and Tanzania, where SHI has been limited to formal sector employees, attempts to ‘roll out’ the scheme to the informal sector have proved extremely difficult.”
It demanded that Zambia’s existing Free Medical Programme must be maintained.
The Forum charged that Zambian citizens have the right to decent quality health care accessible to all adding that with the current economic growth of 6.2%, the country has a good opportunity to start its march towards Universal Health Coverage.
“However, the proposed Social Health Insurance scheme risks excluding the poorest people in the informal sector who will not be able to afford premiums. Now is the time for the Government of Zambia to deliver on its election promises and ensure that decisions made today do not compromise the health of future generations,” it stated.