NHIMA Beneficiaries Want Improved Services As GRZ Launches Nationwide Registration

Protecting families from the risk of high medical bills remains the top priority for both the private and public insurance sectors in Zambia.

Health or medical insurance covers the whole or a part of the risk of a person incurring medical expenses.

Health insurance facilitates access to care and is associated with lower death rates, better health outcomes, and improved productivity. With increasing medical expenses, health insurance acts as a safety net to meet people’s financial needs.

According to the 2020 FinScope survey, 90% of Zambian adults have no emergency savings and 77% cannot raise money to cope with unexpected emergency expenses within 3 days, hence without a health insurance scheme, medical bills can put serious pressure on households’ income.

Therefore, the ability to access services on most private health insurance schemes through the National Health Insurance Scheme (NHIS) is a plus to the insurance industry in Zambia.

Insurance can be defined as a means of protection from financial loss, and Health Insurance, is among the various products currently being offered on the domestic market.

The NHIS was established by Act No. 2 of 2018 as a compulsory scheme to provide reliable health care financing for all Zambian citizens and legal resident, and it is has become part of the country’s path to economic development.

Research shows that this scheme provides free medical access for those aged above 65 and below 18.

National Health Insurance Scheme Authority (NHIMA) has entered into a Memorandum of Understanding with both private and public healthcare providers, which stipulates a service level of 45 days turnaround time for payment of valid claims and currently, its turnaround time is 35 days.

In 2022, NHIMA paid out 1, 038, 747 claims valued at K889, 117, 723, and government has put in place the electronic data interface where 90 percent of accredited health institutions are submitting their claims to ensure faster turnaround time and reconciliations.

However, according to Ministry of Health, only 23 percent of Zambians are currently registered members against the targeted 100 percent.

Despite the benefits that come with health insurance, some beneficiaries on the Copperbelt are calling for an improvement and upgrade in the National Health Insurance Scheme to satisfactory standards.

Victor Kalesha told Money FM News that there are certain medications that are not in the NHIMA package, as patients can only get syrups in the range of K35 and below, a situation that needs to be seriously addressed.

Other beneficiaries, who declined to be named, lament that there have been some inefficiencies in certain NHIMA-accredited facilities in Luanshya, where services only start after 08hrs to 16hrs, while weekends remain closed for operations, making it challenging for patients to access health services.

But for Vincent Chipanta, a Lusaka resident, the health insurance scheme has been very helpful to him and his family because they are able to access healthcare services without worrying about medical bills, despite long queues at most facilities.

In a bid to increase uptake of the services, Ministry of Health recently launched the National Health Insurance Scheme countrywide membership registration and card distribution, which intends to capture at least 50 percent of the population.

Health Minister, Sylvia Masebo is of the view that increased enrollment will help build a more resilient health insurance fund that will finance the health services for all beneficiaries.

Meanwhile, NHIMA Director General Micheal Njapau says the Authority has with technical and financial support from International Labour Organization (ILO) and the Global Fund, embarked on the registration of the poor and vulnerable citizens, adding that the exercise has so far seen about 10, 000 people get registered under the Social Cash Transfer program in Ndola.

In an effort to increase health insurance uptake which currently stands at 23 percent, there is need for industry players to provide products and services that will make the sector relevant to economic growth, and significantly contribute to the country’s Gross Domestic Product (GDP), because the wealth of the nation depends upon the health of its people.