Lifestyle diseases raise new issues on health insurance structures

15Oct 2019
The Guardian
Lifestyle diseases raise new issues on health insurance structures

ALARM has been raised that healthcare resources in the country are being strained as the number of patients suffering from lifestyle diseases, and who as a result need treatment and care for longer periods than communicable diseases, are increasing each passing day. This alarming observation was-

-made by the Health deputy minister Dr Faustine Ndugulile, who was worried if the National Health Insurance Fund (NHIF) would be able to cope with the situation. He did not call for changes in how the fund pays for diseases and instead focused at reducing the spread of such diseases.

Yet it doesn’t need vast research or fertile imagination to realize that eradicating or stemming the rise of non-communicable diseases is like reducing emissions of carbon dioxide into the atmosphere. It is something that the world direly wishes to do but which it quite simply can’t achieve, except by shifting to cleaner energy, not changing patterns of consumption as the most energetic activists prefer. In this matter they promote healthy diets, an excellent idea.

The trouble with the healthy diets campaign is that it is much easier said than done, as the foods that are preferable to individuals and especially when they are in company are precisely the ones targeted in that campaign. There is a danger that we all do the talking and hardly anyone would be listening, and then we rest on our laurels, that everyone has heard the vibrant campaign we have conducted.That is also true of climate change with its interminable debates of who is polluting, who should pay or which forests must be preserved.

The difficult part with the deputy minister’s remarks was the costing pattern and not the diet issue - as the costs are compulsory on the public authorities, even if patients or their families cough up some amounts in the total bill. He said that previously many of the cases reported in hospitals were communicable diseases whereby a patient would stay fit for sometime after treatment before any new treatment was needed. With non-communicable diseases, patients will depend on treatment and medicine for the rest of their lives.

Diseases like diabetes, hypertension, renal and kidney failures are among diseases whose costs for treatment are quite high, he said, pointing out that about a thousand patients suffering from these diseases cost the NHIF about 3.5bn/- a year. This level of costing per person or cohort of health insurance beneficiaries even threatens the sustainability of the fund, the deputy minister calmly noted. So, what is the way out of the situation, so that the fund doesn’t dry up, or patients go untreated for communicable or non-communicable diseases? It is uncertain how far SUA discussants converged on this.

Local experts must start looking at this question closely, as non-communicable diseases ‘modernise’ the social security problem in developing countries, to become similar to developed countries. It is to recognize the right to medical care on the part of everyone, and the limitation of public resources in that regard. The issue is whether health insurance contributions should take into account exposure to specific types of disease, or this is curtailed as a matter of principle. If so, the state will have to conserve resources by contributing much less in non-communicable diseases treatment gradually, to save the situation for the many. With middle income economy it will be easier.