The minister overseeing the respective (health) portfolio has meanwhile started engaging in some form of rearguard action by explaining what is intended as well its rationale.
She must be having in mind the difficulties the government has been having with hiked oil prices, then hikes in cash transfer levies, and now hiked fees to all sorts of avenues in order to boost national health insurance funds.
Not many people are actually aware how this ‘health tax’ is going to be paid, which makes it closer to the disputed levies.
The crucial element of its design is that one must take up health insurance and show a registration card in seeking services. These include a driving licence, motor vehicle insurance, having children pursuing college studies or advanced secondary education, etc.
Bigger personal needs like the provision of travel document (passport); taxpayer’s identification number (TIN), business licence, visa, simcard registration or the provision of a national identification card shall all call for this all-important card.
It more or less replaces the NIDA card in its usage, as its universality for everyone above 18 makes it equivalent to an identity card.
Worldwide, health insurance is essentially individual, but there is no country where free access to basic treatment will be denied if someone has an accident or falls down in a public place and is rushed to hospital from home but cannot pay cash in advance.
This has usually been regretted when it comes up, and often medical personnel are instructed to attend to people and demand payment later. At times patients are restrained in hospitals until bills are paid, and perhaps worse, bodies are kept lying in mortuaries for relatives to pay.
The clincher is that if the insurance is fully voluntary, upwards of 90 per cent of those enrolled will be patients, which is why the government opted to embody it in their services.
The minister said that experience had shown that 99 per cent of people enrolling are already victims of diseases, including NCDs. It is a situation where one takes up insurance to get free treatment for diseases already contracted.
It isn’t surprising that the National Health Insurance Fund and the Community Health Fund schemes become inefficient and overwhelmed, with family-based contributions nowhere nearing the burden that families add to the schemes.
Nor are individual policies suitable as they aren’t big enough and can’t be ballooned, so the ‘cake’ has to be shared out.
Without a wider tax base, health insurance could be available for only a section of employees, and maybe they would not afford sufficiently enhanced contributions for the math to add up, as the basic contributions aren’t high enough.
Even if the new scheme seeks to make medical care available for everyone – and who wouldn’t fancy that? – it is possible that policy designers just won’t decipher the NCDs riddle, the one that is besieging the NHIF’s operations.
At the moment, diseases like malaria, tuberculosis and HIV have mostly free medicines, in which case other momentary disturbances need to be looked at, especially injury.
When it comes to NCDs, though, scaled private payment will be necessary, at least to avoid socially disruptive taxation on the matter.